The System Rules Us: Understanding the Perceptions of Foreign International Medical Graduates in the United States Regarding the Educational Commission for Foreign Medical Graduates' Certification Process



Journal Title

Journal ISSN

Volume Title



Despite efforts to alleviate the current physician shortage, there remains a gap that is not being filled by US medical school graduates especially in under-served and rural areas. One of the solutions to this problem is to use Foreign International Medical Graduates (FIMGs) to fill residency training positions; however, the certification process for these FIMGs is lengthy and often challenging. This qualitative study sought to identify perceptions of the certification process by FIMGs and factors that they feel influence the successful completion of the U.S. certification process. Conceptually, this study was framed within critical theory as well as andragogy. The main research question was: What are the perceptions of FMIGs regarding the factors that influence or impede the ECFMG certification process? Data was collected through semi-structured interviews with six participants. Three participants were FIMGs who are currently U.S. certified practicing physicians, and three participants were FIMGs who are not currently U.S. certified practicing physicians. These interviews provided opportunities for detailed accounts of physicians’ various experiences which served as the basis for all analysis. Carspecken’s methodology was chosen based on its emphasis on systems and cultures through dialogical data collection. The results of these analyses indicated that all six FIMGs in the study perceive the certification process to be stressful due mainly to their status as immigrants and a general lack of support. Furthermore, an important contributing factor to successful certification was internal and external motivations. External motivation came from their families and communities and inner motivation came from a deep desire not to fail. This study may contribute to the field of health sciences education in that it provides insight into the unique experiences of a group of FIMGs, and what educators and leaders in the field can learn about them as adult learners.



International doctors, International students, Medical graduates, Medical students, ECFMG, IMG, FIMG, International, Health education, Foreign doctors, Foreign physicians, Iraq, Nigeria, International students, Adult learners, USMLE, Health sciences, Culture, English language learners