New ACGME recognition for non-standard training of J-1 exchange visitor physicians
International medical graduates who seek entry into U.S. programs of graduate medical education (GME) or training must obtain an appropriate visa that permits clinical training activities. The most commonly used visa to participate in U.S. GME programs is the J-1, a temporary nonimmigrant visa. The Educational Commission for Foreign Medical Graduates (ECFMG) is authorized by the U.S. Department of State (DOS) to sponsor J-1 foreign national physicians in clinical training programs.
ECFMG clinical training sponsorships
All clinical training must be provided within an Accreditation Council for Graduate Medical Education (ACGME)-accredited Sponsoring Institution.
ACGME-accredited programs: ECFMG can sponsor exchange visitor physicians who participate in ACGME-accredited clinical programs or directly associated fellowship programs of GME or training and categorized as J-1 “alien physicians” (defined in 22 CFR §62.27(a)).
Non-standard clinical training: Another ECFMG sponsorship is for J-1 exchange visitor physicians who participate in programs for advanced clinical subspecialty disciplines or pathways where ACGME accreditation and/or American Board of Medical Specialties (ABMS) Member Board certification is unavailable and are considered non-standard clinical training.
Programs seeking to enroll J-1 exchange visitor physicians in non-standard training must ensure that the following requirements are met:
- Non-standard training takes place within an ACGME-accredited Sponsoring Institution and at primary clinical sites for the affiliated program.
- Confirmation that the Sponsoring Institution’s Graduate Medical Education Committee (GMEC) has approved the non-standard training program and associated program description.
- Endorsement by an appropriate ABMS Member Board pursuant to 22 CFR §62.27(e)(4)(i).
New ACGME role and recognition
The ABMS, ECFMG and ACGME jointly submitted a proposal to the DOS for replacement of the current ABMS endorsement requirement for non-standard clinical training of J-1 exchange visitor physicians and for a revision of 22 CFR §62.27(e)(4)(i) to make ACGME the entity responsible for oversight of non-standard training opportunities. The Member Boards are not structured to provide oversight of training programs and/or institutions whereas the ACGME, as the primary national accreditor of GME programs and the institutions that sponsor them, is well suited to provide recognition of Sponsoring Institutions offering such non-standard training opportunities. The DOS officially changed the certification authority for J-1 exchange visitor or alien physicians from the ABMS to the ACGME with rule effective May 19, 2021.
The ACGME will begin recognition of Sponsoring Institutions that offer non-standard training programs for exchange visitor physicians and develop Recognition Requirements to ensure that institutions are providing appropriate oversight of the non-standard training program(s) offered. Once the ACGME Board approves requirements, a new Recognition Committee will be formed to review and monitor institutions seeking to achieve and maintain this recognition. Sponsoring Institutions that provide non-standard training for subspecialty disciplines previously pre-recognized by the ABMS will need to seek recognition from the ACGME.
The ACGME will not recognize individual non-standard training programs as training must be at an ACGME-accredited Sponsoring Institution. Additionally, if there is ACGME accreditation available in the discipline being pursued but the institution’s program is not accredited, such program would not qualify under the non-standard provision for J-1 trainees.
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