Best Practices in Licensing International Medical Graduates

As doctors have increasingly moved around the world, the need to have robust systems for licensing international medical graduates (IMGs) has escalated. In many jurisdictions, governments struggle to deal with establishing processes that are realistic in terms of the development of medical education and professional standards in their country while at the same time assuring the public that IMGs are safe and competent. Examination of several national jurisdictions provides some insights about best practices for licensing IMGs. (full article)

The processes of medical licensing of around the world assure the community that doctors are individually competent and safe to practice medicine. The responsibility for managing medical licensure usually rests with governments or an agency approved by governments. The systems used around the world are quite variable and are evolving quickly. Transnational migration of doctors has become more common resulting in the need for heightened awareness of many issues surrounding medical licensure.  Standards of basic medical education, postgraduate training and professional practice are quite variable around the world.  This makes introduction of identical or comparable systems for licensure more difficult.

Many agencies around the world are grappling with the issues of how to efficiently and effectively develop licensing processes for international medical graduates (IMGs).  An examination of current approaches in a small number of countries (e.g. USA, Australia, Canada, New Zealand, UK) reveals convergence around a set of elements which might be considered best practice when licensing IMGs.  These include:

  1. Proof of graduation from a medical college listed in one of several international directories – the criteria upon which entry of medical schools into some of these directories is quite minimal.
  2. Verification of key documents, at source, conducted by an agency with real expertise in this domain – unfortunately, fraud is a common problem in this area which makes it essential that important documents such as medical degree, records of previous training/experience and any adverse actions taken by licensing authorities are reviewed and verified thoroughly.
  3. Assessment of knowledge by a computerized multiple-choice question (MCQ) examination
  4. Assessment of clinical and communication skills usually by a multi-station Objective Structured Clinical Examination (OSCE) test
  5. Making sure that the tests administered are reliable and valid by expert psychometric analyses of the performance of the MCQ examinations and OSCEs and by benchmarking of the MCQ examinations and OSCEs with graduates from local medical schools who are at a similar stage of professional development
  6. Application of rigorous testing conditions for the MCQ and OSCE examinations with great attention to security of the examination site and the testing materials.  It has become increasingly important that sensitive biometric measures are used to confirm candidates’ true identity (again, unfortunately due to the attempts at fraud in the actual examination setting)
  7. Access for candidates to information about the process including:
    • format and content of the exams;
    • standards against which they will be scored;
    • mechanisms of appeal;
    • expectations and likely outcomes arising from unprofessional behavior and cheating;
    • rules surrounding candidates “selling” recalled questions to commercial testing entities which help students prepare.

These indications of best practice will assist governments and regulatory agencies in building frameworks for licensing of doctors which both protect society and are fair to IMG candidates seeking to move around the world.  Within each of the above areas, there are many nuances in how to approach the various aspects inherent in a medical licensing process.