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FORM J Clinical Clerkship Affidavit & Checklist

Texas Medical Board Required for all international medical graduates. If you dont meet the requirements explained below, you will not be eligible for physician licensure in Texas. Please read the following information very carefully. There are several sections of the statute and board rule relevant to clinical clerkships performed in the United States as part of the medical education of an international medical graduate (IMG). The actual statutory language and board rule are included at the end of this document for your reference. 1. Clerkships performed in the United States by IMGs must be done while enrolled in a US or Canadian LCME or AOA-accredited medical school, either as a regular student or a visiting student, to be eligible for licensure in Texas under current statute. A confirmation letter from an official with the US medical school, such as the Registrar, is required. 2. An applicant who is unable to meet the requirement specified in (1) above may be eligible if the applicant: a. is specialty board certified by a specialty board approved by the American Osteopathic Association or the American Board of Medical Specialties, or, b. participated side-by-side with students in an LCME or AOA-accredited medical school, and was taught by the same faculty as the US students, and provides a confirmation letter from an official with the US medical school, such as the Dean of the medical school or the Dean of Clinical Studies, or, c. performed the clerkship(s) in a hospital or teaching institution sponsoring or participating in a program of graduate medical education accredited, at the time the applicant performed the clerkship, by the Accreditation Council for Graduate Medical Education, the American Osteopathic Association, or the board in the same subject (see the Same Subject section below) as the clerkship.

Required core clinical clerkships, elective clinical clerkships, and the length of medical education all come into play when determining whether an applicants clerkships are acceptable for licensure under (2c) above. Graduates of schools outside of the US and Canada must demonstrate that the education they received is substantially equivalent to that of a Texas medical school. One section of the definition of substantial equivalence names the required core clinical clerkships, which are to be offered in the form of patient-related clerkships. The required core (or fundamental) clerkships are: o o o o o o internal medicine, obstetrics and gynecology, pediatrics, psychiatry, family practice, and, surgery.

(See the Required Core Clinical Clerkships section below to determine if you must demonstrate completion of each of the required core clerkships in addition to demonstrating that the clerkships were performed in an acceptable manner.) Another section of the definition of substantial equivalence mandates the minimum length of medical education to be 130 weeks. These sections of the definition are important because all of the core clerkships (performed in the United States) and only enough weeks of elective clerkships (performed in the United States) to meet the 130-week minimum length of education must be performed under the two conditions described in (1) or (2) above. Elective clerkships performed in the United States above and beyond the 130-week minimum length of education are not subject to the requirements described in (1) or (2) above.
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Therefore, if you: o performed clerkships in core (fundamental) clinical subjects in the United States that were not performed as described in (1) or (2b) or (2c) above, or, o need to use elective clerkships to meet the required minimum length of medical education in the United States that were not performed as described in (1) or (2b) or (2c) above, you are not eligible for physician licensure in Texas unless you are specialty board certified by a specialty board approved by the American Osteopathic Association or the American Board of Medical Specialties.

Same Subject This is the most common reason for lengthy delays of applications and determinations of ineligibility. The phrase same subject which is used in (2c) above has a very specific meaning. Your clerkships must meet the requirement of same subject if you are using (2c) to make your clerkships acceptable. See below for more information and examples. Same subject means the exact same specialty or subspecialty. Examples of acceptable clerkships: A clerkship in Internal Medicine done in an institution with an ACGME or AOA-accredited postgraduate training program in Internal Medicine. A clerkship in Geriatrics done in an institution with an ACGME or AOA-accredited postgraduate training program in Geriatrics (not Internal Medicine, even though Geriatrics is a subspecialty of Internal Medicine). A clerkship in Cardiology done in an institution with an ACGME or AOA-accredited postgraduate training program in Cardiology, not at an affiliated hospital or institution that has no such accreditation. Examples of unacceptable clerkships: A clerkship in Geriatrics done in an institution with an ACGME or AOA-accredited postgraduate training program in Internal Medicine. Clerkships in Pediatrics, Psychiatry, Geriatrics, Emergency Medicine, and Neurology all done under the auspices of an Internal Medicine postgraduate training program in an institution with an ACGME or AOA-accredited Internal Medicine program. Clerkships done in Internal Medicine at an institution that is an affiliate to an institution with an ACGME or AOA-accredited postgraduate training program in Internal Medicine, but has no accreditation itself. Check the ACGME web site to determine whether there was an accredited postgraduate training program in the same specialty or subspecialty as your clerkship at the time you performed your clerkship. Go to: www.acgme.org/adspublic/ and click on Search Programs/Sponsors, then Accredited Programs. You should also search Accredited Program History. Check the AOA web site to determine whether there was an accredited postgraduate training program in the same specialty or subspecialty as your clerkship at the time you performed your clerkship. Go to: www.opportunities.osteopathic.org/search/search.cfm?searchType=1&CFID=1573267&CFTOKEN=51ee76572 ba4a4e1-1DF6A283-0CE8-BE66-2E939680CCE61387&jsessionid=3030c3e398214d202332.

Required Core Clinical Clerkships If you are a graduate of a school not included on the list Schools Whose Graduates Do Not Have To Prove Substantial Equivalence Of Their Education, you will be required to demonstrate completion of each of the required core clerkships.

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Required of all international medical graduates. Do not submit if you are a graduate of a US or Canadian medical school.

Name

_____________________________________________________________________ Printed or Typed Name of Applicant

Medical School _____________________________________________________________________ Printed or Typed Name of Medical School and Location

1. I took courses for my medical education or performed clerkships in the United States during medical school. Yes No (If your response is No, simply complete the signature/date block below, and return this form to TMB.) 2. If the answer to Question 1 is Yes: I was enrolled in an LCME or AOA-accredited school as a regular student for all courses taken and clerkships performed in the United States during medical school and will provide a confirmation letter from an official with the US medical school. I was enrolled in an LCME or AOA-accredited school as a visiting student for all courses taken and clerkships performed in the United States during medical school and will provide a confirmation letter from an official with the US medical school. I participated side-by-side with students in an LCME or AOA-accredited medical school, was taught by the same faculty as the US students, and will provide a confirmation letter from an official with the US medical school. 3. If the answer to Question 1 is Yes: Yes, I am specialty board certified by a specialty board approved by the American Osteopathic Association or the American Board of Medical Specialties. Name of Specialty Board _______________________________________ No, I am not specialty board certified by a specialty board approved by the American Osteopathic Association or the American Board of Medical Specialties.

4. If the answer to Question 1 is Yes: List every course you took or clerkship you performed in the United States during medical school in the following chart, even if you believe you will be eligible for licensure without the need for clerkship evaluation.

Applicant Signature ________________________________________________ Printed Name _____________________________________________________


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Course/Clerkship Performed in the United States Internal Medicine OB/GYN Pediatrics Psychiatry Family Practice Surgery All Other(s). Use additional pages as needed. Begin Date End Date Institution/Facility City, State ACGME/AOA Number

Applicant Signature ________________________________________________ Printed Name _____________________________________________________


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Tex. Occ. Code, Sec. 155.003(b) and Sec. 155.003(c) (b) All medical or osteopathic medical education an applicant receives in the United States must be accredited by an accrediting body officially recognized by the United States Department of Education as the accrediting body for medical education leading to the doctor of medicine degree or the doctor of osteopathy degree. This subsection does not apply to postgraduate medical education or training. (c) An applicant who is unable to meet the requirement established by Subsection (b) may be eligible for an unrestricted license if the applicant: (1) received medical education in a hospital or teaching institution sponsoring or participating in a program of graduate medical education accredited by the Accreditation Council for Graduate Medical Education, the American Osteopathic Association, or the board in the same subject as the medical or osteopathic medical education as defined by board rule; or (2) is specialty board certified by a specialty board approved by the American Osteopathic Association or the American Board of Medical Specialties. Tex. Admin. Code, Sec. 163.4(a)(8) All applicants for licensure that receive any medical or osteopathic medical education in the United States must have obtained such education while enrolled as a full-time or visiting student at a medical school that is accredited by an accrediting body officially recognized by the United States Department of Education as the accrediting body for medical education leading to the doctor of medicine degree or the doctor of osteopathy degree in the United States. This subsection does not apply to postgraduate medical education or training. An applicant who is unable to comply with this requirement must demonstrate that the applicant either: (A) received such medical education in a hospital or teaching institution sponsoring or participating in a program of graduate medical education accredited by the Accreditation Council for Graduate Medical Education, the American Osteopathic Association, or the board in the same subject as the medical or osteopathic medical education if the hospital or teaching institution has an agreement with the applicant's school; or (B) is specialty board certified by a board approved by the Bureau of Osteopathic Specialists or the American Board of Medical Specialties.

Tex. Admin. Code, Sec. 163.5(b)(11) (b) Documentation required of all applicants for licensure. (11) U.S. medical education. Applicants must demonstrate that any medical school education that was completed in the United States in satisfaction of their core basic and clinical science courses as established by the Texas Higher Education Coordinating Board, the Liaison Council on Medical Education, and/or the American Osteopathic Association, and in satisfaction of the 130 weeks of required medical education was accredited by an accrediting body officially recognized by the United States Department of Education as the accrediting body for medical education leading to the doctor of medicine degree or the doctor of osteopathy degree. An applicant who is unable to comply with these requirements may in the alternative demonstrate that the applicant: (A) received such medical education in a hospital or teaching institution sponsoring or participating in a program of graduate medical education accredited by the Accrediting Council for Graduate Medical Education, the American Osteopathic Association, or approved by the board under Section 171.4 of this title (relating to Board-Approved Postgraduate Fellowship Training Programs) in the same subject as the medical or osteopathic medical education if the hospital or teaching institution has an agreement with the applicant's school; or (B) is specialty board certified by a board approved by the Bureau of Osteopathic Specialists or the American Board of Medical Specialties.

Tex. Admin. Code, Sec. 163.5(c)(2)(C) and Sec. 163.5(c)(2)(D) (c) Applicants for licensure who are graduates of medical schools outside the United States or Canada must furnish all appropriate documentation listed in this subsection, as well as that listed in subsections (a) and (b) of this section. (2) Unique Documentation. The board may request documentation unique to an individual unapproved medical school and additional documentation as needed to verify completion of medical
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FORM J
education that is substantially equivalent to a Texas medical school education. This may include but is not limited to: (C) copies of the applicant's clinical clerkship evaluations; and (D) a copy of the applicant's medical school file.

Tex. Admin. Code, Sec. 163.1(12)(B)(iii) and Sec. 163.1(12)(B)(iv) Substantially equivalent to a Texas medical school--A medical school or college shall be considered to be substantially equivalent to a Texas medical school under the following conditions: (B) A medical school operating outside the United States or Canada may be determined to be substantially equivalent to a Texas medical school if the medical school is designed to select and educate medical students and provide students with the opportunity to acquire a sound basic medical education through training in basic sciences and clinical sciences. The school should provide information about the school's program of advancement of knowledge through research; the school's development of programs of graduate medical education to produce practitioners, teachers, and researchers; and, the school's program to provide opportunity for postgraduate and continuing medical education, for the board's consideration. In addition, to be determined substantially equivalent to a Texas medical school, the medical school's characteristics shall include, but not be limited to, the following: (iii) The curriculum shall meet the requirements for an unapproved medical school as set forth in the "Curriculum Definitions for Course Areas Prescribed by the Texas Higher Education Coordinating Board for Determining Eligibility of International Medical Graduates for Texas Medical Licensure," as adopted by the Texas Higher Education Coordinating Board, as follows: (I) The basic sciences curriculum shall include the contemporary content of those expanded disciplines that have been traditionally titled gross anatomy, biochemistry, biology, physiology, microbiology, immunology, pathology, pharmacology, and neuroscience. (II) The fundamental clinical subjects, which shall be offered in the form of required patient-related clerkships, are internal medicine, obstetrics and gynecology, pediatrics, psychiatry, family practice, and surgery. (iv) The curriculum shall be of at least 130 weeks in duration.

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