Performance of United States Citizens with Foreign Medical Education on Standardized Medical Examinations

Abstract

To enter the mainstream of American medicine, United States students who enroll in foreign medical schools must either transfer to a United States medical school (usually after passing Part I of the NBME examination) or complete their studies abroad and then pass FLEX and usually ECFMG examinations. Half those applying for transfer fail Part I. Although virtually all who succeed in transferring subsequently pass Parts II and III, their scores are below the mean of the reference group, and their relative performance progressively deteriorates. Sixty per cent of USFMG's fail the medical portion of the ECFMG examination as compared to an expected failure rate for United States medical students of only 2 to 3 per cent. Thirty-eight per cent of USFMG's who take both ECFMG and FLEX examinations fail the latter. The mean weighted score for USFMG's on FLEX is 75.8, while that for United States graduates is 80.1 and for FMG's 74.7. These preliminary data suggest that United States students who go abroad, regardless of where they complete their studies, do not perform as well on standard tests after they return home as do those who have had their entire education in United States schools. This question needs more systematic study. (N Engl J Med 299:858–862, 1978)