Discovering and Disseminating Knowledge

FAIMER's research agenda strives to investigate and understand the educational experiences and migration patterns of international medical graduates and their impact on the world's populations. The characteristics of medical education and prevailing health care workforce issues are significant influences on health outcomes in regional health care systems. An understanding of the dynamic among medical education, workforce issues, and the quality of health care is essential to improving medical education and, ultimately, the health of all people. FAIMER approaches these issues through knowledge creation, objective analysis, and broad dissemination of results, both individually and with appropriate partners.

The Foundation employs both new and existing resources to create knowledge that can be used to answer questions about medical education and medical graduates internationally. New resources developed by FAIMER, such as the International Medical Education Directory, are invaluable for FAIMER's staff and others involved in medical education research. FAIMER also conducts surveys and studies designed to address specific issues within its scope of inquiry. Other organizations collect and maintain data on various characteristics of international medical graduates. If these various resources could be combined with FAIMER's, the result would provide a more comprehensive picture of international medical graduates, their educational experiences, and practice patterns. To this end, FAIMER seeks to identify existing resources from both private and governmental sources and coordinate the linkage of these resources.

FAIMER's research staff conducts objective analyses of its own data resources and those available from other sources, as well as the results of its own surveys and studies. The results of these analyses are unbiased data, trends, and implications that support policy making and inform public debate on health care issues. The analysis of results from FAIMER surveys regarding its data resources on international medical schools and its programs for medical educators provides valuable feedback and supports the continued enhancement of FAIMER's resources and programs.

FAIMER's audience is the international medical education community and health care consumers throughout the world, and FAIMER is committed to making the results of its research activities broadly available to researchers, physicians, students, credentialing and licensing organizations, policy makers, and the public. Venues for disseminating results are incorporated into project plans at conception and emphasize electronic formats that provide easy, convenient access to updated resources. The wide availability of such resources will assist in efforts to improve medical education and health care that are underway in countless regions worldwide.

Collaborative Research

With the increasing portability of physician credentials, there is a need to better understand the impact of physician migration on the health of societies. Approximately one-quarter of physicians practicing in the United States obtained their medical degrees outside of the country, and it is important to better understand their role in caring for the American public. Relatively little research has been conducted to track the educational experiences and practice patterns of this group of physicians and to quantify their role in providing health care services, especially in underserved areas. During 2003, FAIMER partnered with two organizations to begin to address these issues.

FAIMER and the Association of American Medical Colleges (AAMC) have agreed to collaborate in a study of the educational experiences of a subset of international medical graduates - U.S. citizens who graduate from international medical schools. This group is of particular interest because nearly all U.S.-citizen international medical graduates seek to practice medicine in the United States after completing graduate training, and the results should assist those responsible for health care policy and graduate medical education in the United States.

The study will entail identifying those international medical schools with the largest numbers of U.S.-citizen graduates and gathering information about the schools' educational content, methods, and assessment. The study will conclude with analysis and dissemination of the results through multiple venues. The study, which will be conducted and funded jointly by FAIMER and AAMC, is expected to span two to three years.

FAIMER's joint research program with the Robert Graham Center of the American Academy of Family Physicians continued in 2003. The purpose of this effort is to profile international medical graduates entering Family Practice training, compare them with their counterparts from U.S. medical schools, and seek to determine if there have been changes in the profile over time. Further, it will attempt to determine what roles they fill in the Family Medicine workforce and the nature of their practice.

In addition to addressing issues related to physician migration, the Foundation seeks to understand how differences in the process of medical education relate to health care outcomes. In 2002, the Foundation provided funding for a pilot study, which continued throughout 2003, to evaluate the World Federation for Medical Education's International Standards. These standards are intended as guidelines for use by medical schools worldwide as they engage in institutional self-evaluation, peer review, and the accreditation process. The purpose of this study is to determine whether the standards are universally applicable and whether they can be met by a representative sample of medical schools.

Analyzing Data Resources

In 2003, FAIMER obtained copies of the American Medical Association's Physician Masterfile and the American Association of Medical Colleges' GME Track. These data sets provide information on practicing physicians, including residents, and can be linked to ECFMG applicant and certification records and information from other sources, such as the U.S. Census Bureau. By combining these files, the role of international medical graduates in the U.S. health care system can be explored in detail. For these graduates, country of origin, specialty choice, practice location, immigration status, and whether they fill gaps in underserved areas are a few of the many areas that can be investigated, both cross-sectionally and longitudinally, using this combined data source.

Analysis of individual databases has also proved fruitful. In 2003, the International Medical Education Directory (IMED) database was the source for an analysis of the medical schools in developed and non-developed countries (according to World Bank criteria). The analysis considered parameters such as number and age of medical schools, length of curriculum, and language of instruction. A summary of the results was presented in October by John Norcini, Ph.D., FAIMER President, at the International Network: Towards Unity for Health Conference in Newcastle, Australia.

Evaluating FAIMER Resources and Programs

FAIMER research staff serve as a resource to staff members involved in FAIMER's other areas of activity, tracking medical education and creating resources for medical educators, by designing survey instruments and analyzing their results. FAIMER's 2003 survey of the world's ministries of health, ministries of education, and medical councils will help to verify and expand the medical school information in IMED and to refine plans for collecting information on international accreditation and licensure. FAIMER's 2003 surveys of former Fellows and their mentors will assist in evaluating the efficacy of the fellowship programs. Gathering information about the fellowship experience and its benefits, and the extent to which the goals of the programs are being met, is essential to ensure ongoing improvement in FAIMER's offerings for medical educators.