In our combined 30 years of clinical experience in various teaching hospitals, medical schools, and community health programs in Asia, we have worked with many Asian physicians who have received part or all of their graduate training in the United States. Some have had excellent experiences and have returned to their native country to make important contributions in health care. Many who train in the United States, however, acquire technical skills but fail to acquire the basic clinical skills necessary to appropriately apply their technical skills. As Dr. Levey notes [1], this results from a failure to recognize their less than adequate knowledge in basic sciences and basic clinical medicine before the entire training period has passed.

This failure results in surgeons who return to their native country with some new surgical techniques that yield good "surgical success" but poor outcomes because of, for example, nephrotoxicity brought on by inappropriate use of antibiotics. We have seen internists who became sophisticated in the reading of electrocardiograms and echocardiograms but who did not show a basic understanding of digitalis toxicity.

In summary, graduating medical students possess a wide diversity of basic knowledge and skills, depending on the country of origin. However, the use of inductive reasoning in making clinical judgments, assumed in Western culture, is not a part of many Asian cultures or educational systems. In addition, in our experience, many foreign medical graduates who do well on a written English examination have great difficulty with conversational English.

The decision to train international medical graduates carries with it the responsibility of assuring an adequate medical education.