Yes, I do have some thoughts on the pathways through which IMGs can bypass USMLE Step 2 CS and receive ECFMG certification.
(thread)
(thread)
The messaging from the ECFMG has been that IMGs who complete
a) English proficiency test
-and-
b) one of these five pathways
will be equivalent to IMGs who pass Step 2 CS.
a) English proficiency test
-and-
b) one of these five pathways
will be equivalent to IMGs who pass Step 2 CS.
That’s an interesting assertion.
Because although 95% of US MDs pass Step 2 CS on their first attempt, only around 75-82% of IMGs do.
How, then, can the ECFMG be so confident that the applicants they certify would have passed USMLE Step 2 CS if they’d had the chance?
Because although 95% of US MDs pass Step 2 CS on their first attempt, only around 75-82% of IMGs do.
How, then, can the ECFMG be so confident that the applicants they certify would have passed USMLE Step 2 CS if they’d had the chance?
Here, you’ve got to remember that IMGs are a very diverse group.
Some have extensive practice experience in their home countries; some are freshly-minted graduates.
Some trained in health care systems with limited resources, others in wealthy nations with advanced hospitals.
Some have extensive practice experience in their home countries; some are freshly-minted graduates.
Some trained in health care systems with limited resources, others in wealthy nations with advanced hospitals.
Some are U.S. citizens and native English speakers; others learned medicine in another language and have to translate their knowledge into English.
Some attend schools with minimal accreditation standards; others attend schools just as selective the best in the U.S.
Some attend schools with minimal accreditation standards; others attend schools just as selective the best in the U.S.
The point is, given the diversity in IMGs, it’s logical to expect that some IMGs would have very different likelihoods of passing USMLE Step 2 CS than others.
The 75% overall pass rate probably reflects wildly varying pass rates from very low to very high depending on the group.
The 75% overall pass rate probably reflects wildly varying pass rates from very low to very high depending on the group.
Of course, the ECFMG is in possession of the data needed to carve out certain groups of IMGs who would be expected to have a very high Step 2 CS pass rate.
And when you look at their 5 pathways, that’s what they appear to have done.
And when you look at their 5 pathways, that’s what they appear to have done.
For instance, IMGs who already passed a clinical skills examination in Canada, Ireland, the UK, Australia, or New Zealand (Pathway 2) would be expected to pass USMLE Step 2 at a rate similar to U.S. MDs.
Same goes for Pathway 5 - students from Duke/Cornell’s overseas satellites.
Same goes for Pathway 5 - students from Duke/Cornell’s overseas satellites.
Pathway 3 allows IMGs from medical schools accredited by an agency that is recognized by the World Federation for Medical Education to bypass USMLE Step 2 CS.
Interesting to note which countries this includes... and which are left out.
Interesting to note which countries this includes... and which are left out.
Presumably graduates from these accredited schools have adequate data gathering/PE skills, and the Step 2 CS exam primarily serves as a test of English communication. (That is, IMGs from these schools who fail Step 2 CS did so for the Spoken English Proficiency subcomponent.)
If you had data showing that these IMGs fail the ICE/CIS subcomponents of Step 2 CS at the same rate as U.S. MDs, then replacing the SEP subcomponent with a test of English proficiency would be a legitimate substitute.
(Which, of course, is what the ECFMG did.)
(Which, of course, is what the ECFMG did.)
Pathway 1 allows applicants who have held a full medical license in their country to bypass Step 2 CS.
Yet given the differences between licensure standards in various countries, it’s hard to believe this would result in a homogenous group with a high rate of Step 2 CS success.
Yet given the differences between licensure standards in various countries, it’s hard to believe this would result in a homogenous group with a high rate of Step 2 CS success.
(My guess is that Pathway 1 is included to maintain a pipeline for one of the most sought-after groups of IMG applicants - those who have extensive practice experience in their own country but are willing to repeat residency training in the U.S.)
The bottom line:
The ECFMG’s carved out pathways will result in a pool of newly-certified IMG applicants who would have had a high pass rate for Step 2 CS.
For program directors that rely on IMGs to fill their programs, this is good news.
The ECFMG’s carved out pathways will result in a pool of newly-certified IMG applicants who would have had a high pass rate for Step 2 CS.
For program directors that rely on IMGs to fill their programs, this is good news.
However, it’s bad news for IMGs who fall into groups with lower pre-test probabilities of passing Step 2 CS - and now have no way to demonstrate that they could have passed the test.
And it’s bad news for IMGs who already passed CS, but will be competing for residency positions against some applicants who wouldn’t have.
But rather than making an alternative to Step 2 CS, the ECFMG chose to play the odds... and some applicants are going to be left out.
But rather than making an alternative to Step 2 CS, the ECFMG chose to play the odds... and some applicants are going to be left out.
