Are international and American graduates equally ACGME competent? Results of a pilot study.

Background: Despite a substantial proportion of international medical graduates (IMG) matching to U.S. programs in Internal Medicine, little is known about their readiness in the six medical competencies compared to graduates of U.S. schools (USMG).

Methods: A brief questionnaire with two questions designed to assess basic understanding of each of the six medical competencies (knowledge, patient care, communication, professionalism, systems based- and practice-based learning) was sent by electronic mail to all 1,737 applicants to a community teaching hospital Categorical Internal Medicine Residency Program. Correct responses of IMG were compared to USMG.

Results: Two hundred and eight IMGs were similar except for older age (29 vs 27 years; P = 0.02) compared to 39 USMGs who responded. USMG and IMG had similar percent correct answers (67% vs 62%; P = 0.22). USMG and IMG scored similarly across all but two of the six medical competencies. USMGs more often answered correctly questions on U.S. healthcare economics (39.5% vs 20.4% correct, P = 0.01) and the elements of practice-based learning (69.2% vs 47.5%; P = 0.01).

Conclusions: While this study is limited by its small sample size, it supports a hypothesis that USMG and IMG may differ in their preparedness for systems-based and practice-based learning. This hypothesis deserves exploration in future studies.