ECFMG (Educational Commission for Foreign Medical Graduates) certification allows a physician to work in a hospital training or residency program with supervision.

The United States Medical Licensing Examination (USMLE) for Step 1 (basic sciences) and Step 2 (clinical sciences) must be passed with an overall minimum score of 75, or 182 for Step 1 and 174 for Step 2 on the newer three-digit scale (subject to change). Approximately 55 to 65% of the items must be answered correctly to pass.

The Test of English as a Foreign Language (TOEFL) is required for graduates from foreign medical schools, regardless of the doctor's citizenship. A score of 550 (213 on the computer-exam scale) is required by the ECFMG. The

TOEFL score for the purpose of entry into a residency program is valid for two years. March 3, 1999 was the last date that the ECFMG English Test was available.

To submit your TOEFL score to the ECFMG, send the $40 payment, the date of your TOEFL administration, a official copy of your TOEFL score report, and your ECFMG identification number to:

ECFMG PO Box 820992 Philadelphia, Pa. 19182-0992.

Hint: On TOEFL test day, request that your score be sent directly to the ECFMG by marking the ECFMG institutional code 9108 where recipients are designated.

The Clinical Skills Assessment (CSA), was initiated in July of 1998, and is now required for ECFMG certification. The CSA uses standardized patients (specially trained individuals who simulate symptoms), to test the following skills:

• Spoken English (Conversational comprehension only)
• History taking (Interviewing skills)
• Interpersonal skills
• Physical examination (Ability to administer a focused physical examination)
• Patient note writing (Ability to enter concise information on a patient's record)

This exam is only administered in Philadelphia, PA. Results are scored pass/fail, are not relative to the performance of others, and are available in 6-8 weeks. The CSA score for standard ECFMG Certification is valid for three years for the purpose of entry into a residency program. The CSA may be taken after passing Step 1 and the TOEFL.

USMLE Steps 1 and 2 and CSA: http://www.ecfmg.org (downloadable applications available)

Phone worldwide: 215-375-1913 (24 hours a day for applications) Phone from USA 800-500-8249 (applications only) Questions: 215-386-5900

USMLE Step 3

http://www.FSMB.org (downloadable applications available)

Computer based testing was introduced in May 1999, starting with the USMLE Step 1. Step 2 began in mid August 1999, and Step 3 in December 1999.

Step 1 Format: Step 1 has approximately 350 multiple choice test items that divided into seven 60-minute blocks. The exam (including breaks) is administered in one eight-hour testing day.

Step 2 Format: Step 2 has approximately 400 multiple-choice test items that are divided into eight 6- minute blocks. The exam (including breaks) i s administered in one nine-hour testing day.

Step 3 Format: Step 3 has approximately 500 multiple-choice test items t hat are divided into blocks of 25-50 items. There are also 9 computer-based case simulations. Step 3 is administered in 2 eight-hour testing sessions.

Within a module on either exam, the questions may be answered in any order. Once the time is up for a module, the questions from that module can no longer be accessed. There will be optional 10-minute breaks after each module.

Students must select a three-month eligibility period when applying. They will receive a scheduling permit, which is needed to schedule an appointment at a Prometric Testing Center.

Students may take the exams up to 3 times in one calendar year, but may only apply to re-test after receiving a failing result.

Most hospitals select residency candidates from applicants who participate in the "Match". This system of matching candidates to the appropriate residency training positions allows the candidate to participate in interviews and then privately decide preferences while simultaneously allowing the hospitals to rank those that have interviewed. These preference lists are computer-merged at the National Residency Match Program (NRMP). Results are announced in March. In order to participate in the "Match," exam scores must be ECFMG certified.

There are also possibilities of acquiring a position in the "Post-Match", which fills open positions after the "match.

Hint: Remember that if you rank a hospital and you are offered a position, you are contractually obligated to accept. Don't rank a hospital (even in last place) in which you would not work.

National Resident Matching Program, 2450 N Street NW, Suite 201, Washington, DC 20037-1141, Tel. 202-828-0566 Fax: 202-8283D4797, http://www.aamc.org/nrmp

This service was developed to transmit residency applications, letters of recommendation, Dean's letters, transcripts and other supporting documentation to residency program directors via the Internet. You must use this system for most hospital residency programs. This service is available to International Medical Graduates through the ECFMG. The cost is established by increments based on the number of programs to which you apply. Application Information: http://www.ecfmg.org/erasinfo.htm

FREIDA (Fellowship and Residency Electronic Interactive Database Access) provides specific hospital regulations and information,
http://www.ama-assn.org (Medical Science and Education section)

The Graduate Medical Education "Green Book": 800-621-8335

The NBDE exams are administered by "The Joint Commissions for National Dental Examination".

Part I consists of:

- Anatomic Sciences

• Biochemistry-Physiology
• Microbiology-Pathology
• Dental Anatomy and Occlusion

Each of the four Part I examinations consists of approximately 100 multiple-choice questions. Part I testing dates are July and December of each year. Scores range from 49-99. A scaled score of 75 is considered a passing score.

Part II consists of:

• Operative Dentistry
• Pharmacology
• Endodontics
• Periodontics
• Oral and Maxillofacial Surgery
• Pain control
• Prosthodontics
• Orthodontics
• Pediatric Dentistry
• Oral Diagnosis
• Dental Radiology
• Patient Management
• Dental Public Health
• Occupational Safety

Part II is offered in December and March/April as a written exam, but is available on computer practically any day of the year. Scores range from 49-99, with 75 as a passing score.

211 East Chicago Avenue Suite 1846 Chicago, Illinois 60611 312-440-2678

Each state has unique requirements for licensing, although the NBDE is accepted nationally. Most states require additional course work from international dentists, with passing the NBDE Part I as a prerequisite.

CGFNS (Commission on Graduates of Foreign Nursing Schools)

The CGFNS is an independent, private, non-profit organization established in 1977 to evaluate graduates of nursing schools located outside of the U.S. who are interested in practicing as registered nurses in the U.S. Most of the states require that international nurses obtain a CGFNS certificate. This certification program includes a credentials review, a one-day qualifying exam of nursing knowledge, and a minimum score on the Test of English as a Foreign Language (TOEFL). This program is designed for the first-level, general nurses educated and/or licensed outside of the United States and assesses the nurse's ability to be successful on the NCLEX exam. The CGFNS is administered by the Commission on Graduates of Foreign Nursing Schools, and the exam of nursing knowledge is administered abroad and in several large cities in the United States.

Purpose of the CGFNS certificate:

• Immigrant occupational-preference visa
• Admission to the RN licensing exam (NCLEX)

Exceptions: California, Florida, New York, and other states (Contact State Board of Nursing in state where you want to work.)

Credential Evaluation: CGFNS evaluates the secondary education, nursing education and licensure status of candidates. Prerequisites establish that the candidate:

• Must have graduated from full upper secondary education
• Must have graduated from a general nursing program at a government-approve d nursing school of at least 2 years duration
• Must be a first level, registered, or professional nurse
• Must show evidence of both theoretical and clinical practice in medical, surgical, obstetric, pediatric, and psychiatric nursing
• Must have a valid license to practice as a first level general nurse in the country where the nursing education was received

Qualification Exam: The candidate must take a qualifying examination of nursing knowledge. The following exam information will help you apply:

The exam:

• Is administered in March, July, November with applications due 3-4 months before the date of the exam.
• Costs $295 (effective with the November 2001 exam) for the application and examination
• Can be applied for through: Commission on Graduates of Foreign Nursing Schools, 3600 Market Street , Suite 400, Philadelphia, PA ,19104-2651 USA, (215) 349-8767

The exam format:

Answer and scoring information:

• Answer sheets used to record answers and are machine scored
• No penalty for guessing
• Grading is pass/fail although a numerical score is reported
• Results of the examination are available in 8-10 weeks

English language proficiency examination (TOEFL) is required to:

• Evaluate English proficiency of people whose native language is not English
• Measure listening comprehension, structure and written expression and reading comprehension

The CFGNS requires a score of 540 or higher is required on paper-and-pencil version, a score of 207 or higher is required on the computer version For an application contact: Test of English as a Foreign Language, Educational Testing Service P. O. Box 6151 Princeton, NJ 08541-6151 USA 609.771.7100 http://www.toefl.org

How CGFNS Certification can help you:

• Many State Boards of Nursing in the United States require that internationally educated nurses obtain a CGFNS certificate before the Board of Nursing will approve an application for admission to the Registered Nurse licensing examination (NCLEX-RN)
• The CGFNS nursing examination is modeled after the NCLEX so your preparation for the CGFNS will help you prepare for the state licensure exam (NCLEX).
• The certificate can help you qualify for an occupational visa.

The NCLEX-RN is the examination required to obtain a license to practice as a Registered Nurse in the U.S. Many people still use the outdated term "State Boards" to refer to this nationally standardized examination. The NCLEX is a test of minimum competency designed to evaluate a candidate's ability to provide safe and effective nursing care. The NCLEX is based on the knowledge and behaviors necessary for entry-level nursing practice. The NCLEX examination is written and administered by the National Council of State Boards of Nursing. The National Council consists of 61 Member Boards of Nursing from the individual states and the United States territories of Guam, the Virgin Islands, American Samoa, and the Commonwealth of Northern Mariana Islands.

To obtain a license to work as a registered nurse in the United States it is essential for you to contact the State Board of Nursing in the state where you plan to work to learn how to become a licensed, registered nurse in that state. The State Board of Nursing can provide you with an application for the NCLEX-RN examination. You need to obtain permission to take the NCLEX from the State Board of Nursing. The State Board evaluates your nursing background and credentials along with your English language skills. Each State Board of Nursing establishes its own requirements for nursing licensure. Many states require an internationally educated nurse to obtain a CGFNS certificate before they will accept an application for the NCLEX-RN examination. No single nursing license applies to every state in the U.S. Each State Board o f Nursing issues its own license to Registered Nurses. Once a nurse is license d in one state, it is necessary to apply for a letter of endorsement to obtain a nursing license in another state.

To obtain the address and phone number of the individual State Board of Nursing, contact:

National Council of State Boards of Nursing
676 North St. Clair Street
Suite 550 Chicago, Il
60611-2921
(312) 787-6555
http://www.ncsbn.org

Purpose of the exam:

• The exam is required to obtain a nursing license in the U. S.
• The exam determines if you can give safe and effective nursing care

Test schedule and location:

• Individually scheduled at testing centers in the U.S.
• It is unnecessary for candidates to physically be present and take the exam in the state in which they wish to become licensed. The NCLEX exam is given only in the United States and its territories, but candidates can take the exam in any testing center.

Test format:

• It is a multiple choice objective test with 4 possible answer choices.
• The exam is a Computer Adaptive Test (CAT). That means it is assembled interactively as you answer the questions.
• Computer knowledge is not required to take this exam.
• Questions are selected by the computer according to the accuracy of your previous answers according to the test plan.
• The questions involve nursing content that is integrated, not divided into the clinical categories of medical, surgical, pediatric, maternity, psychiatric/mental health, or community health nursing.
• There is no minimum time limit per question.
• The maximum time limit for the entire exam is 5 hours.
• 15 of the questions are experimental and not scored.
• You will use a computer mouse to highlight and lock-in answers.
• You will answer 75-265 multiple choice questions.

Scoring and results:

• The grading is pass/fail. No score is reported.
• There is no penalty for guessing.
• Results are mailed to you in about two weeks.
• When you pass the NCLEX, you receive a license from the State Board of Nursing to practice nursing in that state.
• If you wish to practice as an RN in another state, you must apply to the State Board of Nursing for a letter of endorsement.
• If you do not pass the NCLEX exam, you receive an individualized diagnostic profile from the National Council stating your overall performance and identifying your strengths and weaknesses.

Test plan:

• Nursing Process:

1. Assessment, 2) Analysis, 3) Planning, 4) Implementation 5) Evaluation

• Client Needs
• 1) Safe, Effective Care Environment a. Management of Care 7-13% b. Safety and Infection Control 5-11% 2) Physiological Integrity a. Basic Care and Comfort 7-13% b. Pharmacological and Parenteral Therapies 5-11% c. Reduction of Risk Potential 12-18% d. Physiological Adaptation 12-18% 3) Psychosocial Integrity a. Coping and Adaptation 5-11% b. Psychosocial Adaptation 5-11% 4) Health Promotion and Maintenance a. Growth and Development 7-13% b. Prevention and Early Detection of Disease 5-11%

Cost: $200

Note: This information is subject to change. Kaplan recommends consulting an immigration attorney for all immigration questions.

The most common visas for International Medical Graduates are F and J visas.

This visa type is for students who will return to their home country upon completing the training program. An I-20 Certificate of Eligibility must b e acquired from an academic institution prior to applying for the for F visa.

Receiving the I-20 certificate does not guarantee that a student visa will b e issued by the Consulate or embassy. Students on an F visa must maintain their student status while in United States.

Kaplan is authorized under federal law to enroll non-immigrant alien students. Kaplan issues I-20 Certificates of Eligibility to those who have met the requirement for admittance. Specific admittance requirements are listed on Kaplan's I-20 application. At Kaplan, maintaining student status requires studying for a minimum of 22 hours per week at a Kaplan Center.

Visitors Program) This visa is the most commonly used by IMG's (International Medical Graduates) to enter a residency. Specific regulations and qualifications are stated in 22 CFR 514.27Z(b) of the Immigration and Nationality Act of the Code of Federal Regulations. Basic requirements include acceptance into an accredited residency program, ECFMG Certification, and English language competency. The application can be made only after you have matched. When all the requirements have been met, the ECFMG may issue an IAP-66 form, which makes you eligible to obtain or convert to a J status.

A notable requirement of the J status is that a physician MUST return to his/her country upon completion of the training program to fulfill a two-year home country residency requirement. Waivers for this requirement are extremely difficult to obtain and include hardship, political asylum, or a request by a government agency on the physician's behalf.

The standard B visa is issued for tourists - nonimmigrant visitors. For those who wish to study for licensing exams or pursue a residency, Kaplan does not recommend entering the United States with a B visa, because converting the B visa to another visa status may be difficult or even impossible. An alternative is the "B Prospective Student Visa". This statu s is appropriate for those entering the United States who do not have an I-20 Certificate of Eligibility and who are not certain which school he or she will attend.

This is the visa of choice for those who plan to work and stay in the U.S.

This visa is valid for three years, extendible up to six years, and requires employer sponsorship. Some hospitals are unwilling to sponsor an H because it attaches responsibility to the petitioning hospital. In many states, the H status requires one year of clinical experience before issuance.

The O visa was established in 1990 for people of "outstanding ability and renown". Proof of such renown must be provided by an outside organization and could be granted to, for example, someone who has practiced medicine for several years and has contributed to medical journals. In most cases an offer of employment and a labor certification that ample attempt has been made to recruit a U.S. national is required. For helpful information about medical licensing exams, visit www.kaplanmedical.com