FAIMER Research Scientist Marta van Zanten Coauthors NEJM Perspective on U.S.-Citizen International Medical Graduates

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FAIMER Research Scientist Marta van Zanten, Ph.D., and N. Lynn Eckhert, M.D., Dr.P.H., of Partners HealthCare International, recently coauthored a Perspective piece for the New England Journal of Medicine, titled “U.S.-Citizen International Medical Graduates—A Boon for the Workforce?” Nearly 14% of applicants for residency positions in the United States are U.S.-citizen graduates of international medical schools (USIMGs), who are more likely to enter primary care fields compared to graduates of U.S. medical schools. The large majority of USIMGs graduated from medical schools located in the Caribbean region. In this Perspective, the authors describe data available on these international medical schools, and outline some of the issues related to Caribbean USIMGs and their contribution to the U.S. physician workforce.

The Perspective appeared in the April 30, 2015 issue (Vol. 372 No. 18) of the NEJM.

John Norcini Is Awarded the Karolinska Institutet Prize for Research in Medical Education

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FAIMER President and CEO John Norcini, Ph.D., has been selected to receive the 2014 Karolinska Institutet Prize for Research in Medical Education for his important contributions to research in medical education, especially his pioneering research on knowledge decay, specialty certification, and the development of new methods of assessment.

Dr. Norcini will receive the award and a prize amount of €50,000 at a ceremony in Stockholm, Sweden, on October 17.

This international prize is awarded for outstanding research in medical education. The purpose of the prize is to recognize and stimulate high-quality research in the field and to promote long-term improvements of educational practices in medical training. “Medical” includes all education and training for any health science profession. The prize is made possible through financial support from the Gunnar Höglund and Anna-Stina Malmborg Foundation. It is currently awarded every second year.

“Professor Norcini’s research output is consistently of the highest originality and quality, and his empirical work has improved the practice of medical education around the globe. His work has had a widespread, positive impact on the research and practice of medical education and has resulted in many subsequent studies by other researchers. He is one of the key contributors to the entire field of research in medical education,” says Professor Sari Ponzer, Chair of the Prize Committee.

For more information, please read the full press release.

New FAIMER Research Supports Value of Accreditation in Medical Education

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Accreditation of medical schools is generally accepted as important, yet little has been published about its impact. FAIMER Research Scientist Marta van Zanten and FAIMER Director of Research and Data Resources Danette McKinley, along with colleagues Irene Durante Montiel (PHIL 2008) and Concepcion V. Pijano, explore the impact of accreditation in Mexico and the Philippines in their recently published paper:

van Zanten M, McKinley D, Durante Montiel I, Pijano CV. Medical education in Mexico and the Philippines: impact on student outcomes. Medical Education. 2012;46(6):568-592.

Findings in the study support the value of accreditation in medical education. The authors specifically examined the performance of a sample of registrants who took at least one of the three United States Medical Licensing Examination® (USMLE®) components required for Educational Commission for Foreign Medical Graduates (ECFMG) Certification, along with another sample of registrants who took all three components. All registrants were from Mexico and the Philippines. Results of the study show that, although there were differences in performance between the two countries, first attempt pass rates on all components were higher for individuals attending accredited medical schools from both countries. In addition, a higher success rate in obtaining ECFMG Certification was associated with registrants from accredited schools in the Philippines who took all three components.

By 2023, physicians applying for ECFMG Certification will be required to graduate from a medical school that has been 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). For more information on the Medical School Accreditation Requirement for ECFMG Certification, please visit www.ecfmg.org/accreditation.

Marta van Zanten Earns Ph.D. and Examines the Value of Medical School Accreditation

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FAIMER Research Scientist Marta van Zanten graduated in May 2012 from the College of Health Professions and Social Work at Temple University, Philadelphia, Pennsylvania, with a Doctor of Philosophy (Ph.D.) degree in Public Health. The title of her dissertation was “The Association between Medical Education Accreditation and the Examination Performance of Internationally Educated Physicians Seeking Certification in the United States.” Dr. van Zanten investigated the United States Medical Licensing Examination® (USMLE®) first-attempt pass rates of all international medical graduates (IMGs) who took one or more examinations leading to ECFMG Certification from 2006-2010 based on the IMG’s medical school accreditation status. Results showed that overall, IMGs who attended an accredited medical school performed better on examinations compared to their peers from non-accredited schools. Accreditation had the strongest association with USMLE performance for IMGs who attended medical schools located in the Caribbean.

In the second phase of this study, the quality of a select group of accrediting agencies was evaluated according to criteria determined by a panel of experts to be the most salient features of an accreditation system. IMGs who attended medical schools with overall higher quality accreditation systems performed better on two of three USMLE examinations. Specific accreditation criteria were associated with better performance on all three examinations. This study lends some support to the value of accreditation globally by linking these systems to improved student outcomes.

FAIMER Staff Members Appointed to Key Positions in AERA Division I

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FAIMER staff members Jack Boulet, Associate Vice President for Research and Data Resources; Danette McKinley, Director, Research and Data Resources; and Marta van Zanten, Research Associate, have been appointed to key positions in Division I of the American Educational Research Association (AERA). Division I – Education in the Professions, is dedicated to promoting research and scholarship in education internationally across professions such as architecture, business, dentistry, engineering, law, medicine, nursing, pharmacy, physical therapy, and teaching. It furthers its mission by supporting scholarly presentations and publications, providing opportunities for professional growth, enhancing communication and outreach, and promoting educational research to inform policy and practice.

Dr. Boulet is serving as Chair of the Division I Program Committee for the 2012 AERA Annual Meeting. The theme of the meeting is “Satis Scire: To Know Is Not Enough,” and it will be held in Vancouver, British Columbia, Canada, April 13-17, 2012. This year, Division I received 119 individual paper and eight symposia submissions. The Division I Program Selection Committee met on October 10, 2011, to discuss and synthesize the many reviews, develop paper session themes, and finalize the program. The program will focus on the development of meaningful educational and assessment programs that go beyond the acquisition and evaluation of knowledge to performance and demonstrated service to the public good.

Dr. McKinley is serving as Co-Chair of the Awards Committee along with Summers Kalishman of the University of New Mexico School of Medicine.

Ms. van Zanten is serving as Editor of PERQ (Professions Education Research Quarterly), the Division I newsletter. The most recent edition of the newsletter, which is the first edition edited by Ms. van Zanten, can be found here.

FAIMER faculty member Ara Tekian of the University of Illinois at Chicago School of Medicine is Vice President of Division I. He was elected to a four-year term beginning in 2009. For more information on AERA Division I, please visit the Division I section of the AERA website.

Study Finds Non-U.S. Citizen International Medical Graduates Provide Same Quality of Care as Physicians Educated in the United States

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Internationally trained physicians are key members of the U.S. physician workforce. The United States has not produced enough nationally educated physicians to meet the country’s health care demands for some time, and internationally trained physicians have made up for this shortfall, comprising approximately 25% of the total U.S. physician workforce. Despite a rigorous certification process, questions have persisted concerning the quality of care that these physicians provide. A new study, published in the August issue of Health Affairs and authored by a team led by FAIMER President and CEO John Norcini, examines the performance of internationally trained physicians compared to their U.S. counterparts, and addresses those concerns:

“Evaluating the quality of care provided by graduates of international medical schools” (Health Affairs, 29(8):1461-1468)
John J. Norcini, Ph.D., FAIMER President and CEO
John R. Boulet, Ph.D., FAIMER Associate Vice President for Research and Data Resources
W. Dale Dauphinee, M.D., FAIMER Senior Scholar
Amy Opalek, M.S., FAIMER Data Resource Specialist
Ian D. Krantz, M.D., Member, FAIMER Board of Directors and Chair, Educational Commission for Foreign Medical Graduates Board of Trustees
Suzanne T. Anderson, Trustee-at-Large, Educational Commission for Foreign Medical Graduates Board of Trustees

The study analyzed 244,153 hospitalizations of patients with congestive heart failure or acute heart attack in Pennsylvania from 2003 to 2006. Patients were treated by physicians who specialized in family medicine, internal medicine, or cardiology. Each physician fell into one of three groups: U.S. medical graduates, U.S. citizen international medical graduates, and non-U.S. citizen international medical graduates. The composition of physicians in the study closely matched that of the total U.S. physician workforce: Approximately 75% of the 6,113 doctors were U.S. medical graduates, with the remaining 25% educated abroad. Of the physicians educated abroad, approximately 75% were non-U.S. citizens and 25% were U.S. citizens.

The study examined both mortality rates and hospital lengths-of-stay as indicators of the quality of care that physicians provide. Among the three groups, in-hospital death rates differed significantly. Non-U.S. citizen international graduates were associated with a 16% decrease in mortality relative to U.S. citizen international graduates and a 9% decrease relative to U.S. graduates. Patients of U.S. medical graduates had the shortest hospital lengths-of-stay, while patients of U.S. citizen international graduates had the longest. The length-of-stay of patients of non-U.S. citizen international graduates was only slightly higher than that of U.S. graduates, indicating little practical difference.

These results provide a measure of confidence in the care provided by non-U.S. citizen internationally educated physicians and highlight the important contribution that they make to the U.S. health care system. As Dr. Norcini points out, “It is reassuring to know that patients of these doctors receive the same quality of care that they would receive from a physician trained in the United States.” He adds, “These findings bring attention to foreign-trained doctors and the valuable role they have played in responding to the nation’s physician shortage.”

Still, the findings concerning internationally trained U.S. citizens elicit a moment of pause. Why did these physicians fare less well in the study? The authors speculate that some of them may seek their education abroad because they were unable to enter U.S. medical schools due to lower grades and/or test scores. Alternately, the quality of education provided at some of the schools attended by these physicians may be of a lower standard than at schools attended by physicians in the other two groups. There may be other explanations as well, and additional research is warranted. Regardless, as U.S. medical schools expand enrollment to combat the shortage of home-educated physicians, some of the students who might have otherwise gone abroad may apply to medical schools in the United States. If that happens, U.S. schools will need to maintain high admission standards to ensure the quality of the physician pool. Further compounding the issue is a lack of proportionate growth in graduate training programs to complement the expansion of medical schools. As Dr. Norcini points out, “If this continues, the current physician shortages will persist and the numbers of foreign-trained doctors will likely decrease significantly.”

In addition to its findings concerning the three separate groups of medical graduates, the study also provided insights applicable to the general physician population. The authors found that in-hospital mortality rates and hospital lengths-of-stay increase with the number of years following graduation from medical school, whereas specialty board certification was associated with lower mortality and shorter hospital stays. These findings point to the need for ongoing training and periodic assessment throughout a physician’s career to maintain a high level of competence, an important consideration for all doctors, regardless of where they received their education.

Marta van Zanten Wins RIME Outstanding Paper Award

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FAIMER Research Associate Marta van Zanten, Ph.D. (cand.), is the recipient of the 2009 Research in Medical Education (RIME) Outstanding Paper Award for the paper, “Medical Education in the Caribbean: Variability in Educational Commission for Foreign Medical Graduates Certification Rates and United States Medical Licensing Examination Attempts,” co-authored by FAIMER Associate Vice President for Research and Data Resources John Boulet, Ph.D. The award will be presented on November 9, 2010, at the RIME Invited Address session at the annual meeting of the Association of American Medical Colleges (AAMC) in Washington, DC.

The paper is the result of research that investigated demographic characteristics and performance outcomes of physicians who received their undergraduate medical education in the Caribbean. The research included almost 20,000 students/graduates who registered for an exam leading to Educational Commission for Foreign Medical Graduates (ECFMG) certification. United States Medical Licensing Examination (USMLE) attempts and ECFMG certification rates (from 1996 to January 21, 2009) were summarized by country of medical school. Results showed that the proportions of females and non-U.S. citizens attending medical schools in the Caribbean are increasing. Average exam attempts for certified individuals ranged, by country of medical school, from 1.19 to 2.84 for the USMLE Step 1 exam, from 1.20 to 2.13 for the USMLE Step 2 Clinical Knowledge (CK) component, and from 1.01 to 1.42 for the USMLE Step 2 Clinical Skills (CS) component and ECFMG Clinical Skills Assessment (CSA). Approximately 14,000 (74.2%) individuals achieved certification, and success rates ranged, by country, from 19.1% to 91.5%. These results highlight the significant variability in performance of Caribbean-educated physicians.

Access to On-line Health Care Services and Systems Resource Free to Latin America and the Caribbean

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Through the Pan American Health Organization (PAHO), free access to the Cochrane Library—a preeminent repository of research on the efficacy of health interventions—is available to individual users in Latin America and the Caribbean region. Versions in English and Spanish are available through the global Virtual Health Library portal at http://www.bvsalud.org.

The Cochrane Library comprises more than 4,000 systemic reviews intended to serve as resources to inform public policy, financial and technological evaluations, clinical guidelines, and supporting clinical decisions. The scientific evidence pertains to policies, programs, and practices aimed at improving health care systems and services. The library is intended for all users, from patients and the general public to health professionals and regulatory authorities.

Medical Education Research Workshop Held in Dhule

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A state-level workshop on Medical Education Research: Concepts and Methodologies was held July 29–30, 2009, at SBH Government Medical College in Dhule, Maharashtra, India. The workshop was conducted with the support of the National Academy of Medical Sciences of India. The focus of the practicum was on identifying and discussing analytical and interpretational error in medical education research in an effort to improve research methodologies. Sessions were held on educational techniques, research methods, quantitative methods, qualitative and mixed methods, differential and inferential statistics, and data analysis. Group projects were conducted on teaching techniques and assessment. The workshop helped build awareness of the need for solid medical education research, and there was much interest in FAIMER fellowship programs expressed among the 25 participants.

Included among participants were 2008 PSG-FAIMER Regional Institute Fellow Amol Dongre, who facilitated a session on the application of qualitative research methods in medical education research, and 2005 GSMC-FAIMER Regional Institute Fellow Shashank Date.

Call for Research Proposals: Alliance for Health Policy and Systems Research and the Human Resources for Health Department, World Health Organization

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A call for research proposals focused on incentives to attract and retain qualified health workers to underserved areas within low and middle income countries has been issued by the Alliance for Health Policy and Systems Research and the Human Resources for Health Department of the World Health Organization (WHO). The Alliance for Health Policy and Systems Research (HPSR) is an international collaboration, based at WHO headquarters in Geneva, which aims to promote the generation and use of health policy and systems research as a means to improve the health systems of developing countries. The Human Resources for Health Department at WHO helps build and strengthen stewardship capacity to develop and implement health workforce policies, strengthens institutional capacity to develop and ensure quality and adequate quantity of health workforce production, and manages knowledge regarding health workforce development.

The Alliance for HPSR and WHO are eager to support pragmatic and policy-oriented research that addresses gaps in the existing evidence base. This call for proposals is open both to studies that aim to understand better the factors behind health workers’ choice of practice location as well as studies that aim to assess the feasibility and effectiveness of interventions to encourage health workers to work in underserved areas. Evaluations that assess the impact of interventions addressing health worker location could examine outcomes in terms of health worker density, but also quality and service coverage.

The deadline for submission of proposals is September 12, 2008. For more information, visit the website of the Alliance for HPSR.