January 9, 2004
EDUCATION REQUIREMENTS FOR LICENSURE OF FOREIGN MEDICAL SCHOOL GRADUATES
By: Saul Spigel, Chief Analyst
You asked about the education requirements graduates of medical schools outside the U.S. and Canada must meet in order to be eligible for licensure as a physician in Connecticut or to work as a resident in a Connecticut hospital.
In order to be licensed as a physician in Connecticut, graduates of medical schools outside of the U.S. or Canada must:
1. show that their education meets specific standards,
2. successfully complete all components of a “fifth pathway program” conducted by an accredited medical school in the U.S. or be certified by the Education Commission for Foreign Medical Graduates,
3. successfully complete a two-year residency in a program accredited by the American Medical Association (AMA) or approved by the state Medical Examining Board, and
4. pass the Department of Public Health (DPH) licensing exam (CGS § 20-10, the last two requirements apply to all licensure candidates).
One way for foreign medical school graduates to meet the education standards is for their medical school to be listed on the World Health Organization's (WHO) World Directory of Medical Schools. But applicants whose schools are not listed can obtain a Connecticut license if they demonstrate their education meets other regulatory standards. They may also be able to obtain a Connecticut license if they first obtain one in another state.
Before anyone can become a resident in a Connecticut hospital, he or she must obtain a DPH permit. In order to obtain this permit, a foreign medical school graduate must show that he has (1) successfully completed all components of a Fifth Pathway program, (2) been certified by the Education Commission for Foreign Medical Graduates, (3) passed the DPH licensing exam, or (4) a current valid license from another state or U.S. territory (CGS § 20-11a).
LICENSURE REQUIREMENTS FOR FOREIGN-TRAINED PHYSICIANS
In addition to the residency and examination requirements all applicants for a Connecticut physician license must meet, students trained in foreign medical schools (those outside of the U.S., its territories, or Canada) must show that their education meets specific standards. These standards, which are set in DPH regulations (see attachment 1), establish two levels of requirements. The first is for students who graduate from a medical school listed on the WHO's World Directory of Medical Schools. Such students are deemed to have satisfied the DPH's educational requirements. The World Directory online version (WHO directory) lists institutions of basic medical education in 157 countries or areas. But it cautions that the WHO does not recognize or accredit any institution, or endorse any training program, listed. (The directory does not list any medical schools in St. Lucia.)
A student from a school not on the WHO list must show that his education meets a series of other requirements.
1. He must have successfully completed at least two years of college study (60 semester hours) before enrolling in medical school. His college coursework must have included biology, organic and inorganic chemistry, and physics. If the college was in the U.S., it must be accredited; if it was elsewhere, the school must be a legally chartered degree-granting institution and its coursework must be the equivalent of an accredited U.S. college.
2. The medical school the applicant attended must be fully licensed and approved by the appropriate regulatory body to offer a doctor of medicine degree.
3. The applicant must have completed a medical program that DPH deems equivalent to that offered in medical schools accredited by the Liaison Committee on Medical Education (LCME). (LCME is the nationally recognized accrediting authority for U.S. and Canadian medical school education programs. It is sponsored by the Association of American Medical Colleges and the AMA.)
An equivalent program comprises coursework and clinical training. The applicant must have had at least 32 months of full-time classroom and clinical instruction that covers, at a minimum, anatomy, biochemistry, microbiology, pathology, pharmacology, physiology, and behavioral science. He must have physically attended the school and lived where the school is located. In addition to coursework, the applicant must have completed at least 72 weeks of full-time, hands-on, supervised clinical coursework of which at least 36 weeks is in medicine, surgery, obstetrics and gynecology, pediatrics, and psychiatry (clinical training in a Fifth Pathway program can be counted toward this clinical coursework).
4. The applicant must have completed clinical coursework in (a) an accredited hospital in the U.S., Canada, or England that has evaluated the applicant in writing and certified to DPH that the scope of his coursework and his performance were equivalent to that required of LCME-accredited medical schools or (b) the hospital that was the primary teaching hospital affiliated with his medical school and staffed by full-time medical school faculty.
The regulations provide alternative ways for foreign-trained medical graduates to show that they have met the undergraduate, medical school coursework, and clinical supervision requirements.
Additional Training or Certification Requirement
In addition to meeting these education standards, a foreign-trained medical graduate must successfully complete all components of a “Fifth Pathway Program” conducted by an accredited medical school in the U.S. or be certified by the Education Commission for Foreign Medical Graduates. The Fifth Pathway program was developed by the AMA's Council on Medical Education to expedite the return to the United States of citizens who are studying medicine abroad. Under this program, students who have completed the academic curriculum at a foreign medical school may substitute a year of supervised clinical training at a U.S. medical school for the internship or social service obligation required by the foreign medical school. It is open to students who completed their premed undergraduate work in a U.S. college or university.
Certification by the Education Commission for Foreign Medical Graduates involves passing four tests: one in basic medical science, two in clinical skills, and English as a foreign language. (OLR report 2002-R-0707, attachment 2, provides more information on these tests.)
License Without Examination
A foreign-trained physician who is licensed in another state can obtain a Connecticut license without taking the DPH examination if (1) the other state's licensing exam is substantially equivalent to Connecticut's, (2) the candidate has met all other licensing requirements, and (3) he is currently practicing and in good professional standing (CGS § 20-12(a)). A foreign-trained physician can also receive a temporary (12-month) license to work in a state facility without taking the DPH examination if he (1) is licensed in another state or (2) graduated from a WHO-listed medical school that the Medical Examining Board determines is equivalent to an accredited U.S. school and has completed an additional year of postgraduate training (CGS § 20-12(c)).