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255.974 Preservation of Opportunities for US Graduates and International Medical Graduates Already Legally Present in the US
In the event of reductions in
the resident workforce, the AMA will advocate for a mechanism of
resident selection which promotes the maintenance of resident physician
training opportunities for all qualified graduates of United States
Liaison Committee on Medical Education and American Osteopathic
Association accredited institutions; and the AMA adopts the positions
that it will be an advocate for IMGs already legally present in this
country. (Res.324, A-97) 255.975 J-1 Exchange Visitor Program (J-1 Visa)
Policy of the AMA
states: the purpose of the physician J-1 Visa Exchange Program is to
ameliorate physician specialty shortages in other countries; and the
AMA will work to correct the problems of inconsistency, lack of
accountability, and non-compliance in the administration of the
physician J-1 Visa Exchange Program identified in the December 1996
General Accounting Office publication Foreign Physicians: Exchange
Visitor Program Becoming Major Route to Practicing in Underserved Areas
(GAO/HEHS-97-26). (CME Rep. 2, A-97)
255.976 Speech Tests for International Medical Graduates
The AMA encourages state
licensing boards to accept ECFMG certification in satisfaction of
requirements for demonstrating English language competence. (CME Rep.
B, A-93) 255.977 International Medical Graduates Participation in Medical Societies
The AMA encourages the
federation of state and county medical societies to identify qualified
and interested international medical graduates to be invited, appointed
and elected to committees and leadership positions within the House of
Medicine. (Res. 217, A-91) 255.978 Unfair Discrimination Against International Medical Graduates
It is the policy of the AMA
to take appropriate action, legal or legislative, against
implementation of Section 4752(d) of the OBRA of 1990 that requires
international medical graduates, in order to obtain a Medicaid UPlN
number, to have held a license in one or more states continuously since
1958, or pass the Foreign Medical Graduate Examination in Medical
Sciences (FMGEMS), or pass the Educational Commission for Foreign
Medical Graduates (ECFMG) Examination, or be certified by ECFMG. (Res.
123, I-90) 255.979 Licensure Of International Medical Graduates
The AMA reaffirms existing
policy regarding licensure by endorsement of international medical
graduates and urges state licensing boards to adopt the recommendations
included in these policy statements. (CME Rep. B, I-90) 255.980 Foreign Medical Graduate Examination In Medical Sciences Scores Not Sole Criteria For Residency Selection
The AMA (1) urges that
Foreign Medical Graduate Examination in Medical Sciences (FMGEMS)
scores not be used as the sole criteria for selecting interns and
residents; and (2) recommends that residency programs consider all of
the candidates' attributes and qualifications during the selection
process. (Res. 143, A-90) 255.981 Graduates of Foreign Medical Schools Involvement in the AMA
The AMA encourages more involvement of graduates of foreign medical schools in its policy-making process. (Res. 144, A-89)
255.982 Equality in Licensure and Reciprocity
The AMA (1) reaffirms its
policy that it is inappropriate to discriminate against any physician
because of national origin or geographical location of medical
education; (2) continues to recognize the right and responsibility of
states and territories to determine the qualifications of individuals
applying for licensure to practice medicine within their respective
jurisdiction; and (3) supports the development and distribution of
model legislation to encourage states to amend their Medical Practice
Acts to provide that graduates of foreign medical schools shall meet
the same requirements for licensure by endorsement as graduates of
accredited U.S. and Canadian schools. (Res. 69, A-89) 255.983 Graduates of Non-United States Medical Schools
The AMA continues to support
the policy that all physicians and medical students should be evaluated
for purposes of entry into graduate medical education programs,
licensure, and hospital medical staff privileges on the basis of their
individual qualifications, skills, and character. (Sub. Res. 45, A-88)
255.984 FMG Participation
The AMA offers encouragement
and assistance to state and county medical societies in fostering
greater participation of foreign medical graduates in leadership
positions at all levels of organized medicine, by providing guidelines
and non-financial incentives, such as recognition for outstanding
achievements by either individuals or organizations in promoting
leadership among foreign medical graduates. (Sub. Res. 20, I-87) 255.985 Graduates of Foreign Health Professional Schools
(1) Any United States or
alien graduate of a foreign health professional education program must,
as a requirement for entry into graduate education and/or practice in
the United States, demonstrate entry-level competence equivalent to
that required of graduates of United States' programs. Agencies
recognized to license or certify health professionals in the United
States should have mechanisms to evaluate the entry-level competence of
graduates of foreign health professional programs. The level of
competence and the means used to assess it should be the same or
equivalent to those required of graduates of U.S. accredited programs.
(2) All health care facilities, including governmental facilities,
should adhere to the same or equivalent licensing and credentialing
requirements in their employment practices. (BOT Rep. NN, A-87) 255.986 Foreign Medical Graduates in Residency Programs
The AMA continues to support
the position that those foreign medical graduates who plan to return to
their country of origin have the opportunity to obtain graduate medical
education in the U.S. (Res. 114, A-86) 255.987 Foreign Medical Graduates
The AMA supports continued
efforts to protect the rights and privileges of all physicians duly
licensed in the U.S. regardless of ethnic or educational background and
opposes any legislative efforts to discriminate against duly licensed
physicians on the basis of ethnic or educational background. (Res. 56,
A-86) 255.988 Report of the Ad Hoc Committee on Foreign Medical Graduates
(1) The AMA reaffirms its
support of current U.S. visa and immigration requirements applicable to
foreign national physicians who are graduates of medical schools other
than those in the United States and Canada. (2) The AMA continues to
support current regulations governing the issuance of exchange visitor
visas to foreign national FMGs, including the requirements for
successful completion of the FMGEMS. (3) The AMA reaffirms its policy that the U.S. and Canada medical schools be accredited by a nongovernmental accrediting body.
(4) The AMA continues to
support cooperation in the collection and analysis of information on
medical schools in nations other than the U.S. and Canada. (5) The AMA supports
continued cooperation with the ECFMG and other appropriate
organizations to disseminate information to prospective and current
students in foreign medical schools. This information should be related
to the structure and requirements of the U.S. system of medical
education and patient care. (6) The AMA continues to
support working with the ECFMG and other appropriate organizations in
developing effective methods to evaluate the clinical skills of FMGs.
(7) The AMA strongly
supports the policy that the core clinical curriculum of a foreign
medical school should be provided by that school and that U.S.
hospitals should not provide substitute core clinical experience for
students attending a foreign medical school. (8) The AMA continues to
support working with the Accreditation Council for Graduate Medical
Education (ACGME) and the Federation of State Medical Boards (FSMB) to
assure that institutions offering accredited residencies, residency
program directors, and U.S. licensing authorities do not deviate from
established standards when evaluating graduates of foreign medical
schools. (9) The AMA, in cooperation
with the ACGME and the FSMB, supports only those modifications in
established graduate medical education or licensing standards designed
to enhance the quality of medical education and patient care. (10) The AMA continues to
support the activities of the ECFMG related to verification of
education credentials and testing of FMGs. (11) Special consideration
should be given to the limited number of FMGs who are refugees from
foreign governments that refuse to provide pertinent information
usually required to establish eligibility for residency training or
licensure. (12) The AMA reaffirms its
existing policy supporting the use of accreditation standards to
enhance the quality of patient care and medical education. Also the AMA
opposes the use of such standards for purposes of regulating physician
manpower. (13) AMA representatives to
the ACGME, residency review committees and to the ECFMG should support
AMA policy opposing discrimination. In particular, these AMA
representatives should emphasize that AMA policy does not prohibit the
appointment of qualified graduates of foreign medical schools to
residency training programs. (14) A study should be
considered to determine the current status of ECFMG certified FMGs who
are U.S. citizens or permanent residents and have not been able to
obtain a residency or secure a license to practice medicine, and
avenues to help them should be evaluated. (15) The AMA strongly
reaffirms existing policy urging U.S. licensing authorities to focus on
the individual academic and personal achievements when evaluating FMGs
for the purposes of licensure. More effective methods for evaluating
the quality of the undergraduate medical education of FMGs should be
pursued and, when available, the results should be a part of the
determination of eligibility for licensure. (16) The AMA reaffirms its
support for the requirement that all medical school graduates complete
at least one year of graduate medical education in an accredited U.S.
program in order to qualify for full and unrestricted licensure. (17) The AMA supports
continued monitoring of the effectiveness of the Fifth Pathway program,
including to the degree possible any measurable impact of the program
on enrollments in Caribbean and Central American medical schools. (18) The AMA reaffirms and
supports publicizing existing policy concerning the granting of staff
and clinical privileges in hospitals and other health facilities. (19) The AMA reaffirms its
support of the participation of all physicians, including graduates of
foreign as well as U.S. and Canadian medical schools, in organized
medicine. (20) The AMA encourages the
constituent medical societies to support qualified FMGs for nominations
to AMA committees and councils. (21) The AMA supports
studying the feasibility of conducting peer-to-peer membership
recruitment efforts aimed at FMGs who are not AMA members. (22) The AMA is committed
to using its existing publications to highlight policies and activities
of interest to FMGs, stressing the common concerns of all physicians.
(23) The AMA supports
demonstrating its interests in issues related to FMGs by publicizing
its many relevant resources to all physicians, especially to nonmember
FMGs. (24) The AMA supports
expansion of its efforts to prepare and disseminate information about
requirements for admission to accredited residency programs, the
availability of positions, and the problems of becoming licensed and
entering full and unrestricted medical practice in the U.S. that face
FMGs. This information should be addressed to college students, high
school and college advisors, and students in foreign medical schools.
(25) The AMA continues to
recognize the common aims and goals of all physicians, particularly
those practicing in the U.S., and supports making every effort to
include all physicians who are permanent residents of the U.S. in the
mainstream of American medicine. (26) The AMA is committed to identifying and publicizing resources within the AMA that will respond to inquiries from FMGs.
(27) The AMA is committed to
providing leadership to promote the international exchange of medical
knowledge as well as cultural understanding between the U.S. and other
nations. (28) The AMA urges
institutions that sponsor exchange visitor programs in medical
education, clinical medicine and public health to tailor programs for
the individual visiting scholar that will meet the needs of the
scholar, the institution, and the nation to which he will return. (29) The AMA is committed
to informing foreign national FMGs that the availability of training
and practice opportunities in the U.S. is limited by the availability
of fiscal and human resources to maintain the quality of medical
education and patient care in the U.S. (BOT Rep. Z, A-86; Reaffirmed:
Res. 312, I-93) 255.989 A Program for Exchange Visitor Physicians
(1) It is the AMA's policy to
separate the issues involved in the support of alien physicians
participating in exchange visitor physician programs for purposes of
education, training and/or research followed by return to their native
lands from the issues involving U.S. citizens who are graduates of
foreign medical schools and alien physician graduates of foreign
medical schools who seek permanent residence in the United States. (2)
The AMA urges government and private funding of the physician exchange
visitor program under the auspices of an appropriate organization that
will: consider the range and type of medical education and health care
needs of those foreign nations sending exchange visitor physicians; the
means to evaluate the level of knowledge and needs of prospective
participants in graduate medical education programs; and identify truly
outstanding public health, geographic medicine, basic medical science,
and clinical training programs to answer the needs of the visitor's
native land. (Res. 107, I-85; Reaffirmed by CLRPD Rep. 2, I-95) 255.990 Regulation of Clinical Education Provided in U.S. Hospitals for Students in Non-LCME Accredited Schools (CME Rep. B, I-85) Rescinded by CLRPD Rep. 2, I-95.
255.991 Education for Foreign Physicians
After reviewing the past and
present status of medical education for physicians of other countries,
the AMA adopts the following statement: (1) Medical education in the
U.S., consistent with available resources, should recognize and respond
to the unique needs of foreign physicians and the environment in which
they practice. (2) A first priority for
the improvement of medical education in all countries should be
directed toward the development of opportunities for medical education
at all levels, undergraduate, graduate, remedial, and continuing,
within the system of medical education existing in the individual
foreign nation or region. (3) U.S. physicians, when
resources are available, should be encouraged to contribute to medical
education conducted in other countries at the undergraduate, graduate,
remedial and continuing levels. (4) The accredited
residency program directed toward practice within the U.S. is an
educational modality which should be limited to foreign physicians who
can be expected to apply what they have learned in the U.S. to the
education or practice needs of their own country. (5) Recognition should be
afforded graduate programs, tailored to the individual needs of the
foreign physicians not involving significant responsibility for the
care of patients, and thus obviating the need for foreign physicians,
otherwise qualified, to pass the Visa Qualifying Examination. (6) Opportunities for
exchange visitor programs of all types pertaining to the improvement of
medical education should be compiled and made available to both foreign
physicians and U.S. physicians who may have an interest in
participating in such programs. (7) Since continuing
medical education is of universal importance, efforts to make
educational materials available on an even wider basis, such as the
foreign language editions of JAMA, deserve commendation. (CME Rep. C,
I-85; Modified by CLRPD Rep. 2, I-95)
255.992 Discrimination Against Physicians
The AMA believes that the
quality of a physician's medical education is an appropriate
consideration in the recruitment and licensure of physicians and
discrimination against physicians on the basis of the country in which
they completed their medical education is inappropriate. (Sub. Res. 44,
A-85; Reaffirmed by CLRPD Rep. 2, I-95)
255.993 Evaluation of Foreign Medical Schools
The AMA continues to support
the efforts of appropriate organizations to gather information that
will assist state licensing authorities in evaluating foreign medical
schools. (Sub. Res. 56, A-84; Reaffirmed by CLRPD Rep. 3 - I-94) 255.994 Physician Exemption from Medical School Standards and Performance Evaluation Requirements
(1) The AMA recommends to
medical licensing boards that those physicians who are foreign medical
graduates currently duly licensed by any licensing jurisdiction in the
U.S. should not be denied endorsement of their licenses, or denied
admission to reexamination when this is required by law, solely because
they are unable to provide documentation of graduation from a school
meeting "equivalent standards and performance evaluation requirements"
to those of programs accredited by the Liaison Committee on Medical
Education. (2) The AMA encourages licensing boards, in reviewing
applications for licensure endorsement, to take into account a
physician's ethical standards and his or her having practiced medicine
of an acceptable quality. (Sub. Res. 108, A-83; Reaffirmed: CLRPD Rep.
I-93-1) 255.995 Foreign Medical Graduates
The AMA believes that (1)
preferential immigration policies for foreign medical graduates should
be terminated and existing immigration laws should be enforced more
strictly; and (2) reduced requirements for licensure should not be
applied under any circumstances to graduates of foreign medical
schools. (Res. 23, A-82; Reaffirmed: CLRPD Rep. A, I-92) 255.996 Foreign Medical Schools
The AMA (1) encourages the
ACGME to work with the ECFMG to study the feasibility of including a
test of clinical skills and knowledge as a component of the
certification process; (2) recommends that at such times as the ECFMG
certificate is validated, the state medical licensing authorities
should accept it as evidence of an FMG having successfully completed
acceptable medical education as required for licensure, if evaluation
of the educational programs of the particular foreign medical school is
not possible; and (3) encourages efforts to develop a system to assist
individual states in the evaluation of the educational programs of
foreign medical schools. (CME Rep. D, A-82; Reaffirmed: CLRPD Rep. A,
I-92) 255.997 Fifth Pathway
(1) The AMA believes that the
Fifth Pathway is fulfilling its purpose of improving the education of
U.S. FMGs who have completed the program and has served to help
maintain standards for licensure in those jurisdictions which would
have been politically pressed to lower them to accommodate these
students without additional education. (2) To reaffirm the intent of
the Fifth Pathway policy, namely to provide an alternative route of
entry into graduate medical education for qualified students studying
abroad who are not eligible through the ECFMG route, the policy should
be revised to ask the sponsoring medical schools to establish more
stringent requirements for admission to and successful completion of a
Fifth Pathway program. (3) The AMA supports the principle that any
existing or proposed alternative programs conducted by U.S. medical
schools to facilitate entry of U.S. citizens studying in foreign
medical schools into U.S. programs should assure that those who
complete such programs are reasonably comparable to the school's
regularly enrolled and graduated students. (CME Rep. D, A-81;
Reaffirmed: CLRPD Rep. F, I-91) 255.998 Foreign Medical Graduates
The AMA supports the
following principles, based on recommendations of the Ad Hoc Committee
on Foreign Medical Graduates (FMGs): (1) The AMA encourages American
specialty boards to adjust certification procedures to FMGs returning
to their home countries. This does not suggest that FMGs should be
awarded certificates on the basis of lower standards, but that
requisites such as post-qualifying practice in the U.S. should be
adapted to FMG diplomats returning home. (2) The AMA supports the
practice of U.S. teaching hospitals and foreign medical educational
institutions entering into appropriate relationships directed toward
providing clinical educational experiences for advanced medical
students who have completed the equivalent of U.S. core clinical
clerkships. Policies governing the accreditation of U.S. medical
education programs specify that core clinical training be provided by
the parent medical school; consequently, the AMA strongly objects to
the practice of substituting clinical experiences provided by U.S.
institutions for core clinical curriculum of foreign medical schools.
Moreover, it strongly disapproves of the placement of any medical
school undergraduate students in hospitals and other medical care
delivery facilities which lack educational resources and experience for
supervised teaching of clinical medicine. (3) The AMA urges the ECFMG to evaluate current methods for determining the proficiency of alien FMGs in the use of English.
(4) The AMA recognizes that
certain state and local medical societies have provided English
language training programs to FMGs and encourages other medical
societies, in areas where there are concentrations of FMGs needing such
training, to consider providing it. Medical societies in areas where
there are few FMGs are encouraged to recommend appropriate language
programs to FMGs in need of them. (CME Rep. F, A-81; Reaffirmed: CLRPD
Rep. F, I-91) 255.999 Final Report of the Ad Hoc Committee on Foreign Medical Graduate Affairs
The AMA (1) For the next
three years, supports actively seeking qualified foreign medical
graduates for nomination or appointment to councils of the AMA. (2) Supports the development of a special effort to recruit FMGs to AMA membership.
(3) Encourages state medical
societies to make an effort to include qualified foreign-trained
physicians among their nominees for medical licensing boards. (4) Supports considering appointing a qualified FMG as one of its representatives to the ECFMG Board of Trustees.
(5) Encourages state, county
and specialty medical organizations to make a special effort to
encourage membership and participation by FMGs. (6) Continues its policy
that U.S. medical schools offer admission with advanced standing,
within the capabilities determined by each institution, to foreign
medical students who satisfy the requirements of the institution for
matriculation. (7) Continues the policy
that U.S. medical schools, within the capabilities determined by each
school, sponsor one year of supervised clinical experience for foreign
medical students in accordance with the criteria established for such
programs by the Council on Medical Education ("Fifth Pathway").
Supports the idea of a study recently authorized by the House of
Delegates to evaluate the effectiveness of these programs. (8) Continues to provide
U.S. students who are considering attendance at a foreign medical
school with information enabling them to assess the difficulties and
consequences associated with matriculation in a foreign medical school. (9) Encourages medical
schools to develop special programs for foreign physicians entering the
United States as exchange visitors. These programs should be designed
to meet the needs of the nations from which the physicians come, as
well as the needs of the physicians. (10) Commends and supports
the American specialty boards for their interest in evaluating oral
examinations and in developing techniques aimed at enhancing the
reliability and validity of oral examinations. (11) Commends and supports
the Federation of State Boards, its several member boards and the ECFMG
in their willingness to adjust their administrative procedures in
processing FMG applications so that original documents do not have to
be recertified in home countries when physicians apply for licenses in
a second state. (BOT Rep. G, I-79; Amended and Reaffirmed: CLRPD Rep.
C, A-90) 275.978 Medical Licensure
The AMA: (1) urges directors
of accredited residency training programs to certify the clinical
competence of graduates of foreign medical schools after completion of
the first year of residency training; however, program directors must
not provide certification until they are satisfied that the resident is
clinically competent; (2) encourages licensing boards to require a certificate of competence for full and unrestricted licensure;
(3) urges the Educational
Commission for Foreign Medical Graduates to continue the development
and careful evaluation of an examination to determine the adequacy of
the clinical skills of graduates of foreign medical schools; (4) urges licensing
jurisdictions to maintain a dual route to licensure by continuing to
endorse the certificate of the National Board of Medical Examiners and
continuing to use the Federation Licensing Examination for licensing
purposes; (5) urges the Educational
Commission for Foreign Medical Graduates to consult with the National
Board of Medical Examiners concerning the possible use of Parts 1 and 2
of the National Board examination for ECFMG certification; (6) urges licensing boards
to review the details of application for initial licensure to assure
that procedures are not unnecessarily cumbersome and that inappropriate
information is not required. Accurate identification of documents and
applicants is critical. It is recommended that boards continue to work
cooperatively with the Federation of State Medical Boards to these
ends; (7) will continue to
provide information to licensing boards and other health organizations
in an effort to prevent the use of fraudulent credentials for entry to
medical practice; (8) urges those licensing
boards that have not done so to develop regulations permitting the
issuance of special purpose licenses. It is recommended that these
regulations permit special purpose licensure with the minimum of
educational requirements consistent with protecting the health, safety
and welfare of the public; (9) urges licensing boards,
specialty boards, hospitals and their medical staffs, and other
organizations that evaluate physician competence to inquire only into
conditions which impair a physician's current ability to practice
medicine. (Amended by: Amended BOT Rep. I-93-13; Amended by: Amended
CME Rep. 10 - I-94); (10) urges licensing boards to maintain strict confidentiality of reported information;
(11) urges that the
evaluation of information collected by licensing boards be undertaken
only by persons experienced in medical licensure and competent to make
judgments about physician competence. It is recommended that decisions
concerning medical competence and discipline be made with the
participation of physician members of the board; (12) recommends that if
confidential information is improperly released by a licensing board
about a physician, the board take appropriate and immediate steps to
correct any adverse consequences to the physician; (13) urges all physicians to participate in continuing medical education as a professional obligation;
(14) urges licensing boards
not to require mandatory reporting of continuing medical education as
part of the process of reregistering the license to practice medicine;
(15) opposes the use of
written cognitive examinations of medical knowledge at the time of
reregistration except when there is reason to believe that a
physician's knowledge of medicine is deficient; (16) supports working with
the Federation of State Medical Boards to develop mechanisms to
evaluate the competence of physicians who do not have hospital
privileges and who are not subject to peer review; (17) believes that
licensing laws should relate only to requirements for admission to the
practice of medicine and to assuring the continuing competence of
physicians, and opposes efforts to achieve a variety of socioeconomic
objectives through medical licensure regulation; (18) urges licensing
jurisdictions to pass laws and adopt regulations facilitating the
movement of licensed physicians between licensing jurisdictions;
licensing jurisdictions should limit physician movement only for
reasons related to protecting the health, safety and welfare of the
public; (19) encourages the
Federation of State Medical Boards and the individual medical licensing
boards to continue to pursue the development of uniformity in the
acceptance of examination scores on the Federation Licensing
Examination and in other requirements for endorsement of medical
licenses; (20) urges licensing boards
not to place time limits on the acceptability of National Board
certification or on scores on the Federation Licensing Examination for
endorsement of licenses; (21) urges licensing boards
to base endorsement on an assessment of physician competence and not on
passing a written examination of cognitive ability, except in those
instances when information collected by a licensing board indicates
need for such an examination; (22) urges licensing boards
to accept an initial license provided by another board to a graduate of
a US medical school as proof of completion of acceptable medical
education; (23) urges that
documentation of graduation from a foreign medical school be maintained
by boards providing an initial license, and that the documentation be
provided on request to other licensing boards for review in connection
with an application for licensure by endorsement; and (24) urges licensing boards
to consider the completion of specialty training and evidence of
competent and honorable practice of medicine in reviewing applications
for licensure by endorsement. (CME Rep. A, A-87) 305.945 Funding of Graduate Medical Education
The AMA: (1) supports the
establishment of an authorization system yet to be specified (for
example, a voucher system) to provide funding for the training program
at the site where training occurs; (2) supports the development of a
portable authorization system for use by US medical graduates,
recognizing that the MD/DO degree is only a mid-point of formal medical
education; (3) supports establishment of an authorization system which
guarantees funding for US Medical Graduates and additional funding for
International Medical Graduates on a competitive basis, based on limits
set by the new public/private sector workforce planning group; (4)
supports the development of alternative options for support of teaching
hospitals to achieve fiscal stability with reductions in Medicare
Indirect Medical Education Adjustment payments and to develop
alternative approaches to provide patient services previously provided
by resident physicians; (5) encourages the use of international
assistance funds to provide for appropriate US training for physicians
from other countries to increase the level of medical care in their
home countries; and (6) supports efforts to allow completion of
training of IMG graduates already in training who might be adversely
affected by an authorization system. (CME Rep. 1, I-96; Reaffirmed by
CME Rep. 13, A-97) 275.983 Licensure
The AMA urges state licensing
authorities or other appropriate state agencies to: (1) bar foreign
medical students from taking core clinical clerkships in hospitals of
their states; (2) undertake meticulous examinations of the credentials
of foreign medical graduates applying for licensure, with particular
attention to the clinical education of these students; (3) cooperate
with the Federation of State Medical Boards in its efforts to secure
and disseminate information on foreign medical schools; (4) develop
and enforce standards that will preclude the granting of licenses to
foreign medical graduates who do not have a degree of Doctor of
Medicine from a school or program that meets the standards of the LCME,
or who cannot demonstrate as individuals comparable academic and
personal achievements; and (5) require successful completion of FMGEMS
for entry into graduate medical education programs. (CME Rep. G, A-86)
295.995 Recommendations for Future Directions for Medical Education
The AMA supports the following recommendations relating to the future directions for medical education:
(28) The AMA recommends to
state licensing authorities that they require individual applicants, to
be eligible to be licensed to practice medicine, to possess the degree
of Doctor of Medicine or its equivalent from a school or program that
meets the standards of the LCME or accredited by the American
Osteopathic Association, or to demonstrate as individuals, comparable
academic and personal achievements. All applicants for full and
unrestricted licensure should provide evidence of the satisfactory
completion of at least one year of an accredited program of graduate
medical education in the US. Satisfactory completion should be based
upon an assessment of the applicant's knowledge, problem-solving
ability, and clinical skills in the general field of medicine. The AMA
recommends to legislatures and governmental regulatory authorities that
they not impose requirements for licensure that are so specific that
they restrict the responsibility of medical educators to determine the
content of undergraduate and graduate medical education. (32) Policies governing the
accreditation of U.S. medical education programs specify that core
clinical training be provided by the parent medical school;
consequently, the AMA strongly objects to the practice of substituting
clinical experiences provided by U.S. institutions for core clinical
curriculum of foreign medical schools. Moreover, it strongly
disapproves of the placement of any medical school undergraduate
students in hospitals and other medical care delivery facilities which
lack educational resources and experience for supervised teaching of
clinical medicine. (33) Methods currently
being used to evaluate the readiness of graduates of foreign medical
schools to enter accredited programs in graduate medical education in
this country should be critically reviewed and modified as necessary.
No graduate of any medical school should be admitted to or continued in
a residency program if his or her participation can reasonably be
expected to affect adversely the quality of patient care or to
jeopardize the quality of the educational experiences of other
residents or of students in educational programs within the hospital.
(34) The Educational
Commission for Foreign Medical Graduates should be encouraged to study
the feasibility of including in its procedures for certification of
graduates of foreign medical schools a period of observation adequate
for the evaluation of clinical skills and the application of knowledge
to clinical problems. (CME Rep. B, A-82; Amended: CLRPD Rep. A, I-92;
Amended by Res. 331, I-95) 305.981 Funding of Graduate Medical Education
The AMA believes that: (1)
Graduate medical education is an essential component of the education
of all physicians. The health and well-being of the American people are
directly benefited by the graduate medical education of physicians.
Societal contributions to the financing of graduate medical education
are appropriate. (2) The education of physicians in graduate medical
education and the clinical care of patients are inextricably linked.
Teaching hospitals should be fully reimbursed for the reasonable costs
of residents' salaries and fringe benefits. (3) All payors of patient
care costs should support graduate medical education in the
institutions in which care for their beneficiaries is delivered.
Support for both direct and indirect costs must include residents
assigned to ambulatory care sites that are essential components of
educational programs (Reaffirmed by Sub. Res. 706, I-94). (4) Funding
from multiple sources should be available to support residency training
programs. (5) Resident physicians should not be permitted to bill
directly for patient care services. (6) In a period of fiscal
constraint, first priority for Medicare funds for residents' salaries
and fringe benefits should be accorded to graduates of medical schools
accredited by the Liaison Committee on Medical Education or the
American Osteopathic Association. Cessation of support for foreign
medical graduates should be phased in over an appropriate time period.
(7) Residents should be compensated reasonably in all programs
throughout the nation. Uncompensated and under-compensated positions
should be discouraged. (8) Reimbursement for patient care by all payors
must be adequate to sustain the nation's teaching hospitals. Adequate
indirect cost payments under Medicare should be continued. Government
must consider and fund separately the care of the nation's indigent.
(BOT Rep. D, I-85; Modified by CLRPD Rep. 2, I-95) 440.984 Mandatory Immunization Requirements for Foreign Students Applying for Visas
The AMA favors requiring that
all foreign students, as well as their spouses and offspring, submit as
a condition for obtaining a visa, acceptable medical evidence that they
have either acquired immunity through previous infection with certain
infectious disease agents or through appropriate immunizations against
same, in keeping with statutory mandates commonly prevalent in this
country. (Res. 11, A-83; Reaffirmed: CLRPD Rep. I-93-1) 540.992 Resident Physician Representation On Advisory Committee For International Medical Graduates
It is the policy of the AMA
that a representative of the AMA Resident Physician Section attend all
meetings of the AMA Advisory Committee on International Medical
Graduates and that this representative participate in all discussions
and deliberations of the Committee. (Sub. Res. 18, I-90)
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