New York's approach to the evaluation of foreign medical schools consists of 2 components. The first concerns the registration or accreditation of some programs. This means that graduates of these programs are subject to the same licensing requirements as graduates of Liaison Committee Medical Education (LCME) and American Osteopathic Association (AOA) accredited schools. The second is the review and possible approval of certain schools for purposes of placing long-term clinical clerks in hospitals in New York state. The graduates of this second category of institutions must meet the same licensing requirements as graduates of any other non-LCME or AOA-accredited institution.

In addition to New York's general requirements for medical licensure, such as age and good moral character, there are specific requirements of education, professional experience or postgraduate training, and examination. The requirement of experience or postgraduate training differs for graduates of registered or accredited schools and graduates of unaccredited or unregistered schools. This latest group of medical schools includes all institutions located outside the United States and Canada, except for the American University of Beirut and the New York Scholarship program at Sackler Medical School in Tel Aviv. These two programs are registered by the New York State Education Department and their graduates are required to satisfy the same licensing requirements as domestic graduates.

The educational requirements for graduates of all types of medical schools are identical:

Completion of at least 2 years of acceptable pre-professional education
Completion of a program of medical education of not less than 32 months
receipt of an acceptable degree

In addition to satisfying the educational requirements and passing the appropriate licensing examination, graduates of accredited or registered programs must complete a year of approved postgraduate training. Graduates of unaccredited or unregistered programs, that is, most foreign medical schools, must pass an acceptable proficiency examination, i.e., be certified by Educational Commission for Foreign Medical Graduates (ECFMG), complete 3 years of approved graduate medical education, and pass the United States Medical Licensing Examination (USMLE).

In 1981, the New York State Board of regents approved regulations governing the circumstances under which students enrolled in unaccredited/unregistered medical schools might engage in clinical clerkships totaling more than 12 weeks in new York state. As provided by section 60.1 of the Regulations of the Commissioner of Education, " Students enrolled in medical programs not registered (by the state education department) may serve in clinical clerkships in teaching hospitals in this state provides that... the program in the medical school attended has been determined by the Department, after a site visit conducted at the expense of the applicant by persons designated by the department and experienced in medical education program evaluation, to meet substantially the requirements of section 60.1 (a)(1) of part 60 and of parts 50 and 52 (of commissioner's regulations). In addition, students wishing to enroll in a teaching hospital with which the medical college has an approved affiliation agreement"

Within this context, a teaching hospital is defined as an institution which has an Accreditation Council of Graduate Medical Education (ACGME) or AOA-Accredited postgraduate training process in those clinical areas in which clerkships are being performed.

The process of evaluating and approving an unaccredited/unregistered medical school seeking to operate a portion of clinical component of its program of medical education in New York State is patterned on the philosophy and procedures of accreditation and registration. Accreditation is a process of determining the quality and integrity of educational institutions or individual programs. The state Education Department's registration process is similar but focuses on individual programs. The resultant recognition entitles colleges and universities to the confidence of the educational community and the public. The accreditation and registration process require institutions and programs to examine goals, operations, achievements, and to be evaluated by a visiting team of peers in the context of standards that are general in nature. Neither registration nr accreditation is inflexible, measuring every institution by fixed and highly specific criteria. In essence, both registration and accreditation are reviewed by colleagues, according to generally stated and commonly accepted indices of quality. The process for approving unaccredited/unregistered medical schools for clerkship purposes is distinguished from registration and accreditation by its more limited scope.

An unregistered and unaccredited medical school may seek approval to place students in clinical clerkships in teaching hospitals in New York State by submitting an application to the State Education Department . The medical school must submit a completed database document along with current catalogs, handbooks, and all other materials concerning the institution's program of medical education. The school must also agree to cover all expenses connected with the evaluation process.
The department's system for the evaluation of medical school programs for the placement of clinical clerks in New York is based on generally accepted procedures for academic program review. the institution presents documents in English and in a format specified by the department that provides information required by the department and relevant to the regulations of the commissioner of education and the guidelines for Evaluation of Medical Programs. The department then designates several people to review these materials. After the initial review of the materials submitted by the school, a site visit team visits the campus and representative clinical facilities, which may be located at other sites, such as New York hospitals.

Prior to the visit , the school requiting approval must provide extensive information concerning the curriculum, faculty , students, resources and administration of the institution. The site visit provides an opportunity to verify the accuracy and completeness of the data and permits an in-depth review of such program components as :

• the depth and breadth of the curriculum and the integration of the basic sciences and clinical experiences

• the use of acceptable standards of admission , the maintenance of student records, and the provision of student services

• the adequacy of basic science facilities, including faculty offices, laboratories, classrooms, libraries and other resources

• the levels of faculty and student morale, intellectual stimulation and academic achievement

Program evaluators use specific guidelines to review the program of medical education. these guidelines include but may not be limited t the following:

The medical school is organized as a definable academic unit , responsible for an educational program of not less than 32 months, which leads to the MD degree or equivalent as determined by the department. The institution is listed in one or more of the generally accepted resource volumes in international education, and its program is legally recognized and approved for the training of the physicians by the competent authorities of the jurisdiction in which it is located.

A completed educational program is maintained , the structure and the content of which provide an adequate foundation in the basic and clinical sciences

An administrative and governing system is provided that allows the schools to accomplish its objectives.

The faculty is composed of sufficient number of representatives of the biological, behavioral and clinical sciences to implement the objectives of the institution.

Acceptable standards concerning admission requirements and the student selection process are in place, and a system is maintained for keeping adequate student records.

Financial resources are available that allows the institution to conduct its program in a satisfactory manner

Adequate facilities, or access to them, including buildings and equipment are available to provide an environment conducive to the maximum productivity of faculty and students in fulfilling the objectives of the school.

In conclusion , the objectives of the New York State Program to regulate clinical clerks from unregistered and unaccredited medical schools are been met. An effective system that clearly defines those conditions under which clerkships may be performed has been established.

This system also exerts quality control measures over the educational experiences available to students. The use of USMLE step 1 as a screening device provides directors of medical education, as well as state officials , with a mechanism for measuring student performance in the basic science areas after 2 years of medical school.

The system and criteria for the review of medical education programs outside of the United States and Canada has had another positive effect. Through an ongoing process of program review , New York state is able to assure that students in selected unregistered and unaccredited medical schools are receiving a reasonable education. This has positive result for both the students and the citizens of New York state. In addition, the medical schools that have been evaluated have benefited from a process based on mutual cooperation and objective assessment. It should also be noted that detailed information concerning unaccredited and unregistered schools, which has never been really available before , is now obtainable from the New York State Education Department. The availability of information concerning these schools and the judgments that have been made based on reasonable standards and procedures are major steps forward in international medical education.

Medical schools approved for this purpose are :

• St.George's university School of Medicine, Grenada

• Ross University School of Medicine, Dominica

• Autonomous University of Guadalajara, Mexic

• Fatima College of Medicine, MAnila, Philippines

• The four year English program St. Medical University of Lublin, Lublin, Poland

• and the four year English Language program at the Medical University of Silesia, Katowice, Poland.