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Should ECFMG Be Concerned with Accreditation Practices in the Caribbean? Five Effective Ways to Streamline the Process

Year: 2025
Type: editorial
Abstract: International Medical Graduates (IMGs) comprise one-fourth of the US physician workforce.1 Certification by the Educational Commission for Foreign Medical Graduates (ECFMG) serves as the benchmark for assessing the qualifications of these physicians before they enter US graduate medical education (GME). 2 The requirements for ECFMG certification applying through pathways include completing the United States Medical Licensing Examination (USMLE) Step 1, USMLE Step 2 Clinical Knowledge (Step 2 CK), attestation of clinical skills, a diploma/transcript from the medical school, and passing the Occupational English Test (OET).3 According to the Federation of State Medical Boards (FSMB), most IMGs come from India, the Caribbean islands, Pakistan, the Philippines, Mexico, etc.There are more than 100 medical schools in the Caribbean region, and approximately 50% of graduates from the Caribbean region enter the primary care fields of the US healthcare workforce.4 In 2010, the Educational Commission for Foreign Medical Graduates (ECFMG) announced that, beginning in 2023, ECFMG certification would require applicants to have graduated from an accredited medical school.5 However, the accreditation policy officially changed in 2024, representing a major development.Under this policy, "recognized accreditation policy" refers to an external quality assurance organization, such as the World Federation for Medical Education (WFME) or the National Committee on Foreign Medical Education and Accreditation (NCFMEA), that has evaluated and approved a medical school's accrediting agency.6 However, many argue that ECFMG should not be concerned with the accreditation of medical schools, as any graduate from an international medical school should pass the USMLE Step 1 and Step 2 CK examinations, which should ensure the quality of a medical graduate.The author argues that the accreditation and accreditation practices should concern ECFMG in the absence of the Step 2 Clinical Skills (CS) examination.USMLE Step 2 CS was an exam administered to medical students/graduates who wish to receive an ECFMG certificate or become licensed physicians in the US However, this exam was discontinued in January 2021.The components that were assessed in Step 2 CS are Communication and Interpersonal Skills (CIS), Spoken English Proficiency (SEP), and Integrated Clinical Encounter (ICE).Given the cancellation of the Step 2 CS exam, the OET examination and ECFMG pathways play a crucial role in the ECFMG certification process.According to Pathway 3, the applicant's medical school is accredited by an agency recognized by WFME.7 As accredited medical schools are attesting their medical students/graduates under pathway three, it is imperative that accreditation practices and clinical training are ensured qualitatively.The author discussed three examples in this editorial and explained why accreditation practices are crucial, as well as the ways to streamline these practices.One of the schools on the island of Grenada is accredited by the Grenada Medical and Dental Council (GMDC).The Grenada Ministry of Health appoints Council members to carry out GMDC's responsibilities, 8 organized into the Registration and Licensure Secretariat and the Accreditation Secretariat.A good regulatory or accreditation body should be independent of the government.This school, accredited by GMDC, contributes 20% of the country's gross domestic product (GDP).In this context, how can anyone ensure that accreditation practices are fair, transparent, and provide equal educational experiences across the 80 clinical sites of this school, especially if the local government is more concerned with economic impact than quality?
DOI: 10.2147/amep.s575000
Language: English
Field: Medicine
Open Access status: gold
Estimated APC paid: $2,320
OpenAlex ID: W4416204834
Cites: 3
Cited by: 2
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