Jama skills study: IMG > AMG

[EBM]

Congratulations to all IMGs everywhere.

http://fyi.cnn.com/2001/fyi/teachers.ednews/09/04/medskul.applications.ap/index.html

contajama.ama-assn.org/issues/v286n9/fpdf/jlt0905.pdf


Keep up the good work. Sounds like some people in American medical schools are getting complacent. Once they're in, they turn on the cruise control.

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[El Duderino]

For those who haven't checked the link out, it says only x out of Y AMG IM/peds residents made a 'proper' abdominal examination, whereas p out of z (where x/y < p/z) IMG residents did.

I wouldn't say this is very good evidence that American medical schools are somehow inferior (they aren't), only that the emphasis on physical examination is shifted elsewhere. When you have the lab a phone call away, you're not going to check for Trousseau or Chvostek, you check serum calcium levels the way everyone else does - a blood sample.

OTOH, obviously a certain level of physical examination skills is needed to diagnose the acute abdomen (which was the case here, IIRC). I would like to know exactly which 13 examinations where required in this particular 'study' before I draw any further conclusions.

 

[Skip Intro]

I discussed this earlier in a thread where certain proponents of the "IMG = inferior" route, especially for U.S. citizens, was hotly debated.

I would say again, as I did before, that a lot of this comes down to the fact that IMGs who want to practice in the U.S. have to pass the CSA, which is a direct test of PE ability as well as ability to interact with the patient.

The CSA test has been called everything from bigoted to unfair to demeaning. It has been likened to a country-club mentality - where certain "unsavory" candidates from an "unfavorable" population have to pony-up to greater membership requirements. This study has, at least in this regard, proven that basic clinical skills of IMGs - possibly as a direct result of having to pass this additional licensure requirement - are at least equal to if not superior than USMGs.

It should be noted, too, that the "powers that be" that control U.S. licensure requirements are planning to soon implement the CSA test for ALL physicians seeking full licensure in the U.S. - that includes USMGs.

And, as far as the argument that a clinician should or would "check serum calcium levels the way everyone else does - a blood sample" precisely argues the point. The marvels of modern technology should not override simple, good, examination-based medical diagnosis. A good clinician SHOULD order ONLY the tests he/she thinks are needed, and not carpet-bomb the lab with a slew of unnecessary and costly blood examinations. Medicine is just as much a practice of understanding signs and symptoms as it ever has been. But, with the increased emphasis on molecular diagnosis, it's no wonder that U.S. schools are focusing less time (possibly) on training in physical examination when there's so much else to cover.

Nonetheless, just because a test exists shouldn't mean you have to order it. Of course, in today's heavy malpractice themed practice environment, it's no wonder that clinicians often reach for the Vacu-tainer in lieu of relying on good clinical examination skills. And, yet we wonder why the costs of U.S. healthcare are skyrocketing...

Still, missing rebound tenderness at McBurney's point is just plain inexcusable.

 

[slave4MD]

I don't know if the article is true or whether it justifies what you're implying.

But one thing we do know for sure is that FMGs did not become AMGs because they were ( in most cases ) academically deficient.

It's not always the same case but answer this: Would you want a risky surgery performed on you by an FMG ? Or would you prefer surgery from a doctor who underwent proper US training?

 

[Kry]

I wouldn't give a damn where my doctor recieved his/her training as long as it was properly recieved.

 

[Annette]

Originally posted by Kry
I wouldn't give a damn where my doctor recieved his/her training as long as it was properly recieved.

HEAR! HEAR!

 

[Winged Scapula]

Originally posted by slave4MD
I don't know if the article is true or whether it justifies what you're implying.

But one thing we do know for sure is that FMGs did not become AMGs because they were ( in most cases ) academically deficient.

It's not always the same case but answer this: Would you want a risky surgery performed on you by an FMG ? Or would you prefer surgery from a doctor who underwent proper US training?

What you've neglected to note slave4md, is that MOST IMGs practicing in the US underwent US RESIDENCY training. The mark of a great physician/surgeon is generally not where he or she went to medical school but rather where he/she trained in his specialty, how well he was trained, and his/her commitment to it.

Some of the best "risky surgery" practitioners in this country did not complete medical school in the US; but many of them came here for residency and/or fellowship training.