orthoguy,
I have simple solution to prevent most of the USIMG's from going out of the country for medical school: open up more medical schools in the U.S. There are at least 20,000 residency spots in the U.S. but only about 16,000 USMG's.
As a USMG, you should know that much of your logic and reasoning is flawed (as already pointed out by others). Before you reply, please, no anecdotal evidence.
And for your reading pleasure...
From JAMA, Sept. 2001
RESEARCH LETTERS
Physical Examination Skills of US and International Medical Graduates
To the Editor: Physical diagnostic skills are considered essential for the practice of medicine,1 but several studies have noted declining clinical skills among US medical school graduates (USMGs).2-4 We conducted a study to measure recent medical school graduates' ability to perform the abdominal examination.
Methods
We defined criterion standards for 13 specific abdominal examination skills (Table 1) in accordance with a textbook that is widely used in US medical schools to teach physical diagnosis.5 These skills relate to performing a general examination of the abdomen as well as examination for suspected acute appendicitis.
We studied 148 first-year residents in internal medicine and pediatrics at our institutions, of whom 113 were USMGs and 35 were international medical graduates (IMGs). Subjects were asked to examine the abdomen of a young adult patient, and each examination was directly observed by 1 of the authors. Inter-rater reliability was established previously ( = 0.93). The performance of the USMGs was compared with the IMGs using the 2 or Fisher exact test as appropriate. International medical graduates with prior residency training were excluded.
Results
Overall, USMGs performed significantly worse than IMGs for each of the 13 skills (P = .001 for each) (Table 1). There were no significant differences between specialties or among residency training programs.
Comment
The clinical skills of USMGs in this sample appears to be suboptimal. We note that participants in this study may not be representative of either the USMG or IMG population. However, USMGs in this study collectively attended 63 different US medical schools and as a group they received a grade of honors in 542 (80%) of the 678 required clinical clerkships during medical school. Thus, their clinical grades place them in the top quartile of USMGs in that year.
As of July 1, 1998, all IMGs were required to pass a clinical skills assessment examination prior to entering US residency programs. Graduates of US medical schools currently are exempt from this national assessment examination. Previous data reveal that approximately 97% of candidates achieve a passing score on this examination and that 80% of candidates undertake special preparation for the test.6 All IMGs in this study successfully completed this examination. Increased attention to clinical skills acquisition may be necessary in medical schools, and residency program faculty may need to conduct an assessment of basic clinical skills at the start of internship and provide appropriate remediation where indicated. To the extent that testing drives learning, it may be desirable to institute a national clinical skills examination for USMGs. The National Board of Medical Examiners is currently pilot testing such an examination for possible future use.6
Philip O. Ozuah, MD, MSEd
Jane Curtis, MD
Albert Einstein College of Medicine
Children's Hospital at Montefiore
Bronx, NY
Eugene Dinkevich, MD
Department of Pediatrics
Downstate Children's Medical Center
Brooklyn, NY
1. Kern DC, Parrino TA, Korst DR. The lasting value of clinical skills. JAMA. 1985;254:70-76. MEDLINE
2. Wiener S, Nathanson M. Physical examination: frequently observed errors. JAMA. 1976;236:852-855. MEDLINE
3. Mangione S, Nieman LZ. Cardiac auscultatory skills of internal medicine and family practice trainees. JAMA. 1997;278:717-722. MEDLINE
4. Mangione S, Peitzman S. Revisiting physical diagnosis during the medical residency: it is time for a logbookand more. Acad Med. 1999;74:467-469. MEDLINE
5. Bickley L, Hoekelman R. Bates' Guide to Physical Examination and History Taking. 7th ed. Philadelphia, Pa: Lippincott-Raven; 1998.
6. Whelan G. High-stakes medical performance testing: the clinical skills assessment program. JAMA. 2000;283:1748. FULL TEXT | PDF | MEDLINE
Letters Information
Guidelines for Letters
Letters Section Editors: Stephen J. Lurie, MD, PhD, Senior Editor; Jody W. Zylke, MD, Contributing Editor
