[Updated on 4/12/2018]
Will I be able to practice in Canada, in the U.S., or near home? Is Trinity approved, accredited, recognized? Can Caribbean medical school students compete with U.S. Medical students in the Residency match? These are some of our most frequently asked questions from prospective students considering Caribbean medical schools. To help answer these questions, we've gathered the relevant information from the appropriate sources: the American Medical Association (AMA), the Educational Commission for Foreign Medical Graduates (ECFMG) and from the individual state medical boards of North American. We hope to bring clarity to the vast amount of misinformation and opinion generated by internet searches, pre-med forums and other less-than-reputable sites.
As the only CAAM-HP (Caribbean Accreditation Authority for Education in Medicine and other health Professions) accredited school in St. Vincent, Trinity School of Medicine is particularly excited to announce that CAAM-HP's standards in St. Vincent and the Grenadines have received formal approval from the US Department of Education's National Committee on Foreign Medical Education and Accreditation (NCFMEA) on October 24th, 2016, joining 23 other recognized countries.
There is no single standard by which the federation of U.S. Medical Boards or the Canadian authorities are guided in consideration of licensing physicians. Physician licensure is controlled by the medical boards of the 50 U.S. States and 13 Canadian Provinces and Territories, each with their own rules and procedures for qualifying an individual to practicing medicine within their jurisdiction. Because this information is subject to change at any time by any of the governing authorities, we encourage prospective students to frequently visit the medical boards of the regions where they have an interest in practicing. [Federation of State Medical Boards Directory.]
With the release of the American Medical Association's 2014 State Medical Licensure and Statistics publication, new details are available warranting an update from our previous article on the topic of where Trinity graduates are eligible to practice and where they have matched for residency training.
According to the recent State Medical Licensure and Statistics publication, less than half of U.S. state medical boards use a list of approved/unapproved foreign medical schools for initial licensure decisions.
Historically, California maintained a Recognized List and a Disapproved List of medical schools. Some states follow one or both of these lists. Other states reference the lists while offering additional means of demonstrating eligibility for licensure. Trinity School of Medicine will be deemed approved by the Medical Board of California as of 1/1/2020. As Trinity has met the new MBC requirements since its accreditation was recognized by the NCFMEA in 2015, any students starting now would be able to match into California residencies by the time they graduate.
The following are states that use the lists maintained by the Medical Board of California. As changes in California legislature has changed the way the state maintains their lists, check this space for further updates from the medical board decisions of the states listed below. Please note as you read that, irrespective of the new approval status, Trinity has never been disapproved by California.
Alaska & New Mexico - CA's Recognized List
Colorado - References CA's Recognized list as well as the CAAM-HP list (an accreditation Trinity holds) as means of approving foreign medical schools.
Indiana - Trinity has been independently approved by the Indiana medical board. Normally, Indiana references CA's Recognized and Disapproved lists. However, Trinity applied independently after one of our graduates was offered a position at an Indiana hospital and our approval was granted. With this, Trinity joins only five other foreign medical schools approved by Indiana.
Tennessee - References CA's Recognized list, the U.S. Department of Education's NCFMEA list (on which our accreditation is recognized) and CAAM-HP (our accreditation). Trinity School of Medicine has a graduate in fellowship and licensed to practice medicine in Tennessee.
Alabama, North Dakota and Vermont - Reference CA's Disapproved List. As Trinity has never been disapproved, there are Trinity graduates in residencies in Alabama and North Dakota.
There have been recent, major legislative changes in the state of California that will take effect as of January 1st, 2020. The full details are available here, but to summarize: California has done away with their legal mandate to maintain the individual evaluation of international medical schools by the Medical Board of California (MBC), instead deferring to new, stringent quality standards chosen by the MBC. If a school is found to substantially comply with these requirements, they are deemed approved by the Medical Board of California.
Trinity School of Medicine already substantially complies with these requirements. Graduates of Trinity School of Medicine can apply to residencies and for licensure in the state of California as of January 1, 2020.
Read this link for more details on these exciting developments.
Trinity SOM is recognized as being on the lists of the World Health Organization (WHO) and the International Medical Education Directory (IMED) published by the Foundation of Advancement for International Medical Education and Advancement (FAIMER). The following represents U.S. states that reference the above lists as a qualification for International Medical Graduates (IMGs) applying for licensure. (There are Trinity graduates in residency or practicing at each of the following, as well. See the map below for full coverage).
Connecticut - WHO
Indiana - IMED/FAIMER
Louisiana - WHO, IMED/FAIMER
Maine - IMED/FAIMER
Minnesota - IMED/FAIMER
New Jersey - IMED/FAIMER
Rhode Island - WHO
The state of Texas maintains a list of approved (“Substantially Equivalent”) international medical schools. To become recognized as Substantially Equivalent, a graduate of the medical school must apply for licensure. The license application will include a submission from the school evidencing that it meets standards substantially equivalent to those of accredited U.S. medical schools. After one or more graduates of the school have been granted licenses, the Board may elect to add the school to the Substantially Equivalent list. Trinity has not yet had a graduate apply for a practice license in Texas.
Idaho requires that an International medical school demonstrate that their degrees are substantially equivalent to the degrees issued by acceptable medical schools located within the United States if the event that the IMG applying for licensure applies less than 15 years from when the school issued their first degree. A Trinity graduate Matched to a residency in the state of Idaho in 2018. Trinity was also granted a permanent waiver to the 15 year rule in its 10th year of operation by the Idaho medical board.
Massachusetts requires that The Board of Registration review an applicant’s medical school training and/or off-site clinical rotations to determine whether they are substantially equivalent to U.S. medical school training. A Trinity graduate has secured licensure and Trinity School of Medicine has been deemed to have equivalent U.S. medical school training as of April 2018.
If the state(s) of interest to you is not represented above, it is likely in the majority of states that do not require that an applicants' medical school be state board approved. Year after year, dating back to 2007, between 25%-29% of licenses issued by state medical boards (allopathic and osteopathic) have gone to IMGs.
Medical licensing authorities in the U.S. require that IMGs be certified by the Educational Commission on Foreign Medical Graduates (ECFMG) to obtain an unrestricted license to practice medicine. The ECFMG, through it’s program of certification, assesses whether IMGS are ready to enter accredited residency or fellowship programs in the U.S. ECFMG certification is a requirement for IMGs who wish to enter such programs. This certification is also one of the eligibility requirements for IMGs to take Step 3 of the United States Medical Licensing Exam.
The USMLE is a 3-step exam for medical licensure in the U.S. for US medical graduates as well as IMGs. It is designed to assess a physician’s ability to apply knowledge, concepts and principles and to demonstrate fundamental patient-centered skills, that are important in health and disease and that constitute the basis of safe and effective patient care. The USMLE is a single examination with 3 steps. The USMLE is sponsored by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME).
To be eligible for ECFMG certification and participation in the U.S. Residency Match, IMGs must satisfy the medical science requirement (USMLE Step 1 and Step 2 CK or equivalent exam) and clinical skills requirement (Step 2 CS). Steps 1 and 2 of the USMLE play a significant role in demonstrating a medical student's proficiency and knowledge and their scores on these exams are used in the residency application process for both the U.S. and Canada. Residency directors focus on these scores because they are comparable across applicants.
The map below shows the states and provinces where Trinity graduates have successfully matched for residency training through participation in both the National Residency Match Program (NRMP) and the Canadian Resident Match Service (CaRMS).
With organizations such as the American Medical Association advocating on behalf of IMGs, the potential exists for a more standardized evaluation process regarding licensure in the future. It is unlikely that individual states will abandon their current practices, instead they may adopt new policies or recognize additional accrediting bodies for foreign medical schools. While states and provinces continue to include IMGs in their healthcare workforce we encourage applicants to visit the websites of the states where they may desire to practice to understand the process and policies. The AMA, ... strongly reaffirms existing policy urging the US licensing authorities to focus on the individual academic and personal achievements when evaluating IMGs for the purposes of licensure.
References: American Medical Association's State Medical Licensure Requirements and Statistics 2014; Educational Commission on Foreign Medical Graduates: www.ecfmg.org; Federation of State Medical Boards: http://www.fsmb.org/