JULY 2008

Issue Topic:

Medical Education In the USA

VOLUME 2 : ISSUE 3

education USA

CONNECTIONS In This Issue:

Medical Education in the USA Note from the Editor: Admission to medical education in the United States is competitive. So competitive, in fact, that many undergraduate institutions in the U.S. appoint a pre-med adviser whose job it is to help guide American students through the process of applying to medical school. Medical school competition is even steeper for international students. According to the American Association of Medical Colleges, of the 1,371 international students who applied to medical school in 2007, only 164 matriculated. The picture is a bit more encouraging for international students interested in enrolling in medical residency programs – in the 2008 National Resident Matching Program (NRMP), 45 percent, or 4,650 of the 10,300 graduates of non-U.S. medical schools who applied, matched to a first year position. Still, the application process is arduous, and includes a series of written and practical exams in addition to the complicated NRMP. In this issue, you will find information on U.S. medical education, including fast facts, online resources, and insight from EducationUSA advisers whose Professional Advising Leadership (PAL) Programs focused on the field. Rohayma Rateb, adviser at AMIDEAST in Alexandria, Egypt, simplifies the daunting process of applying to U.S. medical residency programs by breaking it down into five easy steps. Margaret Anyigbo, an EducationUSA adviser in Lagos, Nigeria, offers your students ten tips for applying to medical school. And, to provide an American administrative perspective on current trends in U.S. medical education, Connections interviewed Dr. Huda M. Ayas, Executive Director of the Office of International Medicine Programs at The George Washington University. You will also find a special analysis of the impact of the falling dollar on international student enrollment and study abroad, featuring observations by the REACs on trends in their regions. And for your students, Olivia Emilia, from Mobility International USA, answers frequently asked questions about studying in the U.S. for students with a disability. It was a pleasure to meet so many EducationUSA advisers at NAFSA, and I hope to meet others of you in the coming year. Please continue to contact me with your suggestions for upcoming issues. – Shannon Bishop, Editor, Connections Senior Program Manager Institute of International Education [email protected]

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Features 2 Interview with Dr. Huda M. Ayas, Executive Director of the Office of International Medicine Programs at The George Washington University Discussion of Dr. Ayas’ views on medical education in the U.S. including current and future trends.

5 Five Steps for Applying to Medical Residency Programs in the U.S. Outlines the steps for applying for a medical residency in the United States and gives tips on how to advise students as they undergo the process. By Rohayma Rateb, EducationUSA Adviser, Alexandria, Egypt

7 Ten Tips for Applying to U.S. Medical Schools Advice for students interested in attending medical school in the U.S. By Margaret Anyigbo, EducationUSA Adviser, Lagos, Nigeria

Departments 8 Technology Resource How To: Easy Ways to Use Technology in Advising Step-by-step instructions for how to use Skype and for setting up your computer to handle multiple languages.

9 Student Resource Studying in the United States with a Disability: FAQ Outlines the opportunities available for international students with disabilities who are interested in studying in the U.S. By Olivia Emilia, Mobility International USA

10 Arm Chair Tour Featured Center: Tunis,Tunisia Interview with adviser Leila Zahmoul.

12 News/Updates Special Analysis of the Impact of the Falling Dollar

Interview: A Conversation with Dr. Huda M. Ayas, Founder and Executive Director of the Office of International Medicine Programs, The George Washington University

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onnections interviewed the Founder and Executive Director of The George Washington University’s International Medicine Program, Dr. Huda M. Ayas, to provide readers with insight to the current issues and trends in American medical education, and to offer an inside perspective on how international students engage in U.S. medical education.

increasing enrollment of U.S. students. One group, concerned about quality of service and English language ability, argues for less reliance on international medical graduates. On the other hand, international medical graduates tend to take positions in rural areas and community hospitals that U.S. graduates do not find attractive.

Connections: How is U.S. medical education Dr. Huda M. Ayas Dr. Ayas founded GW’s Office of International Medicine adapting to the current needs in the United States? Programs in 1994 and has developed and implemented many international medical education and training programs. She is curDr. Ayas: A prominent discussion in medical education pertains rently working with the non-profit Physicians for Peace, the to curriculum development to meet the changing medical needs of Ministry of Health of Eritrea, and the Orotta School of Medicine to our society. For example, we currently face the challenge of figuring develop and implement a graduate medical education model in out how best to care for the aging Baby Boomer generation. In Asmara, Eritrea. She is fluent in Arabic and French. addition, with the escalating cost of healthcare, some feel more Connections: What are some of the major issues in the field of medicine in the United States? Dr. Ayas: In 2004, the Association of American Medical Colleges (AAMC) announced a shortage of U.S. physicians, invalidating a prediction made in the early nineties that there would be a surplus. This shortage has resulted from changes in the American healthcare system (insurance, third party providers, etc.) that have caused students to live in places and specialize in fields that pay more and offer better qualities of life. Specifically, the medical field has experienced a shortage of physicians in particular medical specialties and in rural areas of the country. Popular specialties today include plastic surgery, dermatology, and anesthesiology. Shortages are more severe in pediatrics, surgery, and infectious diseases. In 2005, the AAMC Joint Assembly announced the goal to increase total medical school enrollment by 30 percent in a decade. This objective is being met in two ways: First, existing medical schools have been encouraged to increase enrollment by a self-determined percentile, depending on infrastructure (faculty, library space, etc). The second approach is to create new medical schools, the number of which was forever held constant at 125. New medical schools have recently opened in Florida, Texas and Arizona. Connections: What effect does this have on international medical students or graduates? Dr. Ayas: A related debate questions whether we should rely on international medical graduates to fill the shortage of U.S. doctors, instead of

emphasis should be placed on prevention, rather than treatment. Advocates such as AAMC, Liaison Committee on Medical Education (LCME), and Accreditation Council for Graduate Medical Education (ACGME) also perceive a need to include cultural sensitivity/awareness training. The question is not whether doctors need these skills, but rather how best to adapt the already overloaded curriculum to prepare future physicians. Connections: Though international students account for less than two percent of total medical school enrollment, foreign graduates constitute twenty five percent of all medical residents. What accounts for this large difference? Will this trend continue? Dr. Ayas: It is extremely difficult for international students to compete for a seat in a U.S. medical school; thus, they end up doing their undergraduate medical education in their home country and apply to post-graduate medical education in the U.S. instead. GW, for example, receives around 15,000 applications each year for 180 spots (up from 150). Specifically, international medical students have a hard time competing with American students on the language elements of the application, scoring poorly on the verbal section of the MCAT and writing weak personal statements. The latter is often a result of cultural differences as some students are raised to downplay personal accomplishments. Many international students also do not receive the same advising support American students get from the pre-medical community. The advising process needs to start at the high school level, not in the third year of the bachelor’s degree. C O N T I N U E D

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Interview: A Conversation with Dr. Huda M. Ayas C O N T I N U E D

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Resources on U.S. Medical Education Accreditation Council for Graduate Medical Education (ACGME) – Responsible for the accreditation of post-MD medical training programs within the United States. Accreditation is accomplished through a peer review process and is based upon established standards and guidelines. www.acgme.org Ross Hall, home of GW’s International Medical Programs.

In addition, one of the requirements of the Doctor of Medicine degree at American medical schools is that applicants must have a bachelor’s degree (or 90 credit hours) from a U.S. university or a college, which creates another barrier for international students who want to apply to U.S. medical schools. However, students that have a foreign medical degree and do well on the USMLE can apply to an American residency program. The trend of low international student enrollment in U.S. medical education will continue unless we do something about it. Here at GW, for example, we designate five seats every year for international students, meaning they only have to compete against each other for those spots, instead of against the 15,000. We receive around 40-50 international applications each year. I have not heard of another U.S. med school with a similar program. Despite the mandate from the AAMC to increase medical school enrollment, the American Council on Graduate Medical Education (ACGME) has not issued any statement to increase the number of residencies. Moving forward, this will make it more difficult for foreign medical graduates to be accepted into residency programs. Connections: What aspects distinguish U.S. medical education from medical education in other parts of the world? Dr. Ayas: There are differences in both degree structure and course content. Most foreign medical schools are based on either the French or British system. They are more commonly based on the British system, which requires six years of training and one year of internship to achieve an MD degree. In the first two years, students study prerequisites such as algebra, physics, and English and move on to the molecular sciences in their third and fourth years. The last two years consist of clinical rotations. Most of them become general practitioners after they complete their last year of internship and never pursue any specialization. C O N T I N U E D

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American Medical Association (AMA) – The American Medical Association enables doctors to help patients by uniting physicians nationwide to work on the most important professional and public health issues. www.ama-assn.org Association of American Medical Colleges (AAMC) – Serves as the voice and advocate for academic medicine on medical education, research, and health care. www.aamc.org Educational Commission for Foreign Medical Graduates (ECFMG) – Through its program of certification, the Educational Commission for Foreign Medical Graduates (ECFMG) assesses the readiness of international medical graduates to enter residency or fellowship programs in the United States that are accredited by the Accreditation Council for Graduate Medical Education. ECFMG issues the USMLE/ECFMG Identification Number. www.ecfmg.org National Association of Advisers for the Health Professions (NAAHP) – An organization of over 900 health professions advisers at colleges and universities throughout the United States. www.naahp.org National Resident Matching Program (NRMP) – A service which provides an impartial venue for matching the preferences of applicants and programs. www.nrmp.org United States Medical Licensing Examination (USMLE) – Students must have completed at least three years of medical school to apply for any of the required USMLE exams, which include the Step 1 Medical Sciences exam and the Step 2 Clinical Knowledge (CK) and Clinical Skills (CS) Exams. www.usmle.org/Examinations/index.html

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Interview: A Conversation with Dr. Huda M. Ayas C O N T I N U E D

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In contrast, the standard medical degree in the U.S. takes four years to complete. Students must have a bachelor’s degree (or the equivalent of 90 credit hours) and all the necessary prerequisites before entering. In the first two years, students take both basic sciences and Practice of Medicine (POM), where they are introduced to patient care through a simulation center, ‘treating’ actors who are hired to behave like patients. There was actually a mandate in the nineties to change the American curriculum and introduce students to clinical care earlier in the program. We introduced POM at GW in the mid-nineties and it has proved to be very effective in improving students’ clinical skills. Introduction of POM early in the curriculum is catching on at foreign medical schools. American medical education also tends to focus on the hard sciences as opposed to public health. Schools in Africa, Europe and the Middle East base their curricula on the specific needs of their country. Countries with public health issues require students to do internships in infectious diseases or community health. This is especially advantageous in Africa, where students come out trained to treat the most prevalent ailments. These types of experiences are optional for students in the U.S., instead of being embedded in the mandatory curriculum. The problem is time; you can only fit so much in.

Connections: What factors should international students reflect on when considering U.S. medical education (either medical school or residency)? Dr. Ayas: Students need to consider their long term career plan: Are they planning to stay in the U.S. or go back to their home country? Students who do medical school in the U.S. usually end up doing their residencies here as well to fully complete their training. Students who do not plan to stay need to keep an eye on their home country and think carefully about what they will do when they return. Students should focus on a specialty their country needs. Connections: What advice do you have for international students who hope to study in U.S. medical schools? Dr. Ayas: In addition to having a strong GPA, performing well in sciences, and scoring well on the MCAT (students must have scores in the double digits in each section), international students need to market themselves effectively and differentiate themselves from the other applicants. Students need to show that they have taken on a passion for something in life—it doesn’t matter what—to indicate they will be passionate about their patients. International students have rich experiences and should be proud of their background. Sometimes I think they forget this in an effort to integrate with American society.

10 Facts About Medical Education in the U.S. 1.

Approximately twenty-five percent of all physicians in the U.S. are trained internationally, according to the Educational Commission for Foreign Medical Graduates.

2. 3.

There are 129 accredited medical schools in the United States according to AAMC.

4. 5. 6.

The average tuition and fees for first year non-resident medical students for 2007-2008 was about $40,000.

According to AAMC, American medical schools enrolled 1,104 international students in 2007. This is 1.6 percent of the total U.S. medical school enrollment.

The standard U.S. medical school curriculum is four years long. In order to gain admittance to a U.S. medical school, a student must have a bachelor’s degree (or the equivalent of 90 credit hours).

7.

In 2005, the AAMC Joint Assembly announced the goal to increase total enrollment by 30 percent in a decade to counteract the shortage of physicians in the United States.

8.

In the 2008 National Resident Matching Program, 45 percent of the 10,300 graduates of non-U.S. medical schools who applied to U.S. residency programs, matched to a first year position.

9. 10.

The length of medical residency programs varies from three to seven years, depending on the specialty. The most popular medical specialties in the United States are dermatology, orthopedic surgery, and urology, according to AAMC. This fact sheet was derived from data provided by the Association of American Medical Colleges, www.aamc.org. E d u c a t i o n U S A / C O N N E C T I O N S

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Five Steps for Applying to Medical Residency Programs in the U.S. Feature

By Rohayma Rateb

U.S. residency programs offer an excellent opportunity for aspiring doctors from around the world to further their education and gain excellent experience. There are roughly 8,000 residency programs in the United States. While this process might seem quite daunting, a basic understanding of the different testing, evaluation and matching processes will help you advise students on how best to navigate the path to a successful residency. What follows is a step-by-step explanation of the basic process.

Step 1

Complete the ECFMG Application

The first step in the process is for students to apply to the Educational Commission for Foreign Medical Graduates (ECFMG,

Guide to United States Medical Licensing Examinations (USMLE)

www.ecfmg.org) for a USMLE/ECFMG Identification Number.

www.usmle.org

Because of the variety of educational standards, curricula, and evaluation methods across the world, the Accreditation Council for Graduate Medical Education (ACGME) requires a standardized

Medical Sciences Exam: An eight-hour, computer-

testing procedure for all international applicants. Be sure to famil-

based, multiple-choice exam covering knowledge in the

iarize yourself with the information available on the ECFMG web-

basic medical sciences: anatomy, behavioral sciences, bio-

site. The website provides the eligibility requirements for starting

chemistry, microbiology, pathology, pharmacology, physi-

the certification process and walks you through the process of

ology and interdisciplinary topics. The exam costs USD

applying for the required exams online through an Interactive Web

$825.

Application. The exams are offered a number of times throughout the year and are described in more detail on the chart to the right.

Step 2

Take the United States Medical Licensing

Examination (USMLE) Medical Sciences, Clinical Knowledge and Clinical Skills Exams Students must have completed at least three years of medical

Clinical Knowledge Exam (CK): A nine-hour, computer-based, multiple-choice test that covers clinical sciences including diagnosis, the understanding of disease mechanisms, and care management principles. The Step 2 CK costs USD $840.

school to apply for any of the required USMLE exams, which include the Step 1 Medical Sciences exam and the Step 2 Clinical Knowledge

Clinical Skills Exam (CS): An exam to ensure that

(CK) and Clinical Skills (CS) Exams. These same tests are also

graduates of medical schools demonstrate the ability to

administered to graduates of U.S. and Canadian medical schools.

gather and interpret clinical patient data and communicate

The Step 1 exam is aimed at testing general scientific knowledge,

effectively at a level comparable to students graduating

whereas Step 2 assesses a student’s ability to put this knowledge

from U.S. institutions. The day-long exam must be taken

into practice with a patient. Students should also refer to the

at a regional clinical skills evaluation center in the United

ECFMG Information Booklet to see whether these exams can be

States. It consists of twelve fifteen-minute examinations of

substituted with any of the medical science exams they have taken

standardized patients, with ten minutes to compose a writ-

previously. All three tests must be passed within a seven-year peri-

ten record of the encounter (Patient Note). Students will

od; if all three are passed, results do not expire. The Step 1 and Step

be graded on their medical history and physical examina-

2 CK Exams are administered worldwide at Thomson Prometric test

tion data-gathering skills, communication and interperson-

centers. The Clinical Skills exam must be taken in the United

al abilities, and English language proficiency. The fee for

States. Students must obtain a scheduling permit from ECFMG to

this exam is USD $1,200.

register and schedule the test date with Prometric. C O N T I N U E D

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Five Steps for Applying to Medical Residency Programs in the U.S. C O N T I N U E D

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Apply to Residency Programs

Step 4

Match with a Program

After passing the required exams and achieving ECFMG certifica-

In February, following the interview process, both applicants and

tion, students can apply to the residency programs of their choice

programs rank each other through the National Resident Matching

through the Electronic Residency Application Service (ERAS).

Program (NRMP), a service which provides an impartial venue for

Applications are submitted during September and October. ERAS

matching the preferences of applicants and programs. In March of

is a service developed by the Association of American Medical

2008, 15,242 graduates of American medical schools and 4,650

Colleges (AAMC) to transmit residency applications, letters of

graduates of non-U.S. medical schools were matched to a first year

recommendation, dean’s letters, transcripts and other supporting

residency position. The positions that are not filled in the initial

documents to residency program directors.

match process are then listed on the NRMP website. These positions can be filled in as quickly as an hour.

After reviewing the applications, admissions officers invite select applicants for interviews, which typically take place during

Step 5

November, December and January. Here, admissions officers fur-

Following acceptance, medical schools send accepted students an

ther evaluate applicants based on the general competencies

information packet, contract, and temporary license. The J1 visa is

required of residents: patient care, medical knowledge, practice-

the typical visa for residents although some applicants are able to

based learning and improvement, interpersonal and communica-

acquire an H-1B visa if they have taken Step 3 of the USMLE tests or

tion skills, professionalism, and systems-based practice.

apply for a waiver program to work for two years in an underserved

Obtain a Visa

area. Once the final certifications have passed between the student, Because these programs are highly selective, it is wise for students

the interlocutor agencies and the medical program, students should

to spend time researching all the potential residencies that would

contact their U.S. Embassy or Consulate to set up a visa interview

be a good fit given their academic background and professional

and inquire about all of the documents required for their visa

goals. The Graduate Medical Education Directory (Green Book) and

(www.unitedstatesvisas.gov).

the Accreditation Council for Graduate Medical Education (ACGME) are good resources for this research.

Rohayma Rateb is the EducationUSA adviser at AMIDEAST in Alexandria, Egypt.

Tips for Students How to prepare for a successful residency interview.

How to find a residency program that will be the

• Call the program secretary to check for current doctors from

best fit.

your own country or region in order to connect with someone currently involved with the program.

• Study

the program’s website. Familiarize yourself with the faculty – their professional backgrounds, areas of expertise, and involvement in educational and training programs.

• Clearly communicate personal goals during the interview.

• Do not limit yourself to one specialty area.

Conduct thorough research on alternative fields that may be of interest.

• Remember that certain specialties tend to be more competi-

tive than others. Programs such as internal medicine, family medicine and pediatrics take only three years and are less competitive, while specialties such as surgery, cardiology, ophthalmology and psychiatry, among others, are more competitive and require additional time.

• Present previous experiences in an articulate and organized fashion. • Send a thank you note after the interview to express continued interest in the program.

• Talk to as many current residents as possible. Find out if you click with them.

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Ten Tips for Applying to Medical School in the U.S. Feature

By Margaret Anyigbo

etting into medical school in the United States is highly competitive for any student, but even more so for international students. Of the 129 medical schools in the United States, only 50 enroll international students. Any international student who is determined to apply should keep the following tips in mind:

G

1. Doctors are not all science majors.

9. Have a financial plan.

Medical school admissions officers are interested in diverse educational backgrounds and appreciate students with a variety of talents and interests. Regardless of your major, be sure to take the biology, general and organic chemistry, physics, math and English requirements and have a good GPA.

Financing medical school may be your biggest challenge. If scholarship money is not available, students must prove they have the ability to pay $200,000 or get a co-signer.

2. Take the process seriously. The process is expensive and should not be taken casually. It requires total commitment, maturity and intellectual ability. You will be under a lot of pressure.

3. Consider where you have the best chance of enrolling. Research and apply to schools that will be the best fit; however, be sure to investigate how many international students have been enrolled in the past. You will have a better chance getting into private medical schools. State schools favor U.S. citizens and state residents.

4. Take the MCAT once. Some medical school admissions negatively view taking the MCAT multiple times. Students should aim for a minimum score of 10 in each of the three sections.

5. Perfect the personal statement. Prove you pay attention to detail by submitting a polished piece. Do not be shy. This is your opportunity to market yourself; be sure to highlight your achievements, strengths and leadership qualities.

6. Prepare for the interview. The interview is an elimination process. Interviewers are not looking for standard answers but rather responses that distinguish the applicant. They want to find out how well students can think on their feet.

7. Choose references carefully. The evaluation should be written by someone who can attest to your ability, someone like a pre-med adviser, science department professor or member of the university pre-medical committee. Submit a profile to the recommendation-writer, providing information he or she might not already know, such as your involvement in extracurricular activities.

8. Find an internship. Admissions officers highly regard students who have volunteered or interned in a healthcare-related setting. From observing the medical profession first hand, you will learn whether it is the right fit for you and what specialty you might want to pursue.

10. Seek advice from others in the field. Students should take advantage of their environment and discuss medical school plans with professors and classmates. Professors might have suggestions that guide students down the right path. Classmates and other pre-medical students going through the same admission process can share insight about the experience. Margaret Anyigbo is a EducationUSA Adviser in Lagos, Nigeria.

What to do if you don’t get accepted to medical school in the United States 1. Don’t despair. Regroup and apply again. Before re-applying, consider participating in volunteer work that is healthcare-related to showcase leadership qualities. 2. Consider an MD/PhD program. MD/PhD programs come with full funding; however, a student must demonstrate interest in research. 3. Consider an accelerated Post Baccalaureate premedical program. These programs are rigorous but helpful for students who lack strong science backgrounds. However, they do not guarantee admission to medical school. 4. Apply to be a Physician’s Assistant (PA). A physician’s assistant is an advanced practice clinician licensed to practice medicine with the supervision of a licensed physician. Before applying to PA programs in the U.S., check to see whether this position exists in your country. 5. Postpone going to the United States until residency. Obtain a medical degree at home or in another country outside the United States, and then apply for a U.S. residency. Chances of obtaining a residency in the U.S. are better for students who have degrees from a U.S.-affiliated medical school outside the U.S. E d u c a t i o n U S A / C O N N E C T I O N S

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How To: Easy Ways to Use Technology in Advising Technology Resource

How to set up and use Skype.

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ownload Skype software for free onto your center’s com-

Set up Windows to work in more than one language.

puters to enable students to talk, chat or video conference

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with center alumni studying in the U.S. or admissions officers.

using the language bar, which appears at the bottom of your

All you need is an internet connection and a headset with a

screen in the task bar. This is especially helpful for producing

microphone. Skype to Skype calls are free. Calling land lines

multilingual materials and is much quicker than inserting

or mobile phones directly costs a minimal fee. You can also

symbols when you need to use special characters.

indows makes it easy for you to flip between languages

buy a voicemail service to retrieve calls when your computer is switched off. Note: Skype can be a strain on your server.

How To: Step 1

Go to www.skype.com, click on download, and run

How To: Step 1

Select the Control Panel from the Start Menu.

Step 2

Click “Date, Time, Languages, Regional Options” and then “Regional Language Options”.

the Skype Setup application. Then follow the Setup Wizard (you will be asked to create a username and

Step 2

password) and launch Skype.

Step 3

On the Languages Tab, click “Details”

To get started you can use the “pay as you go” func-

Step 4

Click Add and a new window will appear. In the Add

tion and add Skype credit (starting USD $10) to your

Input Language Window, make sure the “Keyboard

account to pay for calls when you make them or pay a

Language/IME” box is checked, then select desired

monthly fee (starting USD $30) to get unlimited calls

language from the dropdown list.

to the places you call the most.

Step 5 Step 3

The new language will now appear under “keyboard”

Add contact names and numbers to your Skype

in the list on the Settings tab in the Text Services and

account. Calling a Skype account anywhere in the

Input Languages Window. In Preferences section at

world is free.

the bottom of the window, select Language Bar. Make sure the “Show the Language Bar on Desktop” is

Step 4

Skype Out. You can dial any land line or mobile phone

checked.

if you add credit to your account (by credit card or PayPal). Remember to dial the country prefix.

Step 6

Click “Apply”, then Click “OK”. You should now see the language bar as part of your task bar. Select what

Step 5

Distribute your center’s Skype Account name to your

ever language you would like to use. Note: On the

students before they depart for the U.S. This way they

language bar, be sure both the keyboard icon and

will be able to correspond with you for free and act as

the language icon are set to the desired language.

a resource for prospective students.

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Studying in the United States with a Disability: FAQ Student Resource

By Olivia Emilia

Thousands of people with disabilities attend university in the United States. As a student with a disability, you have many of the same concerns as any other student. However, you may also have unique questions concerning the culture at U.S. universities for students with disabilities. What follows are the answers to the most frequently asked questions.

What is the Americans with Disabilities Act (ADA), and will it protect my rights if I study in the U.S.? The ADA is a law that protects the rights of people with disabilities from discrimination. Because of the ADA, U.S. universities and exchange programs are required to provide students with disabilities equal access. As an international student, you will be protected by the ADA when you study in the U.S. How and when do I ask for disability-related services?

International students with disabilities study English at the American English Institute.

Soon after acceptance, you should contact your school’s disability services office. Provide information about your disability and dis-

The definition of disability is different in other cultures. It may be dif-

cuss any disability-related services, also called “reasonable accom-

ferent in your culture. For example, in some countries non-apparent

modations”, that you may need to access course and campus activ-

disabilities such as learning disabilities or mental health conditions

ities. Common examples of reasonable accommodations include

are not widely recognized as disabilities. Also, some services that are

extra test-taking time, sign language interpreters, or readers. The

typically provided by family members are provided confidentially by

school is not required to provide services that are considered per-

professionals or done independently in the U.S., using assistive tech-

sonal, such as a personal attendant or sighted guide for daily living

nology or adaptive equipment.

tasks. If you are living on campus, your housing must be accessible and wheelchair-friendly.

What advice do you have for me as a person with a disability who hopes to study in the U.S?

Am I required to tell my university that I have

While studying in the United States you may feel very far away from

a disability?

the people who usually provide you with support. Use this as an

It is your personal choice whether to tell your school about your

opportunity! People with disabilities in the U.S. are expected to do

disability after you are accepted. If you are requesting services, you

as much as possible on their own, and to be a self-advocate. This

may need to provide proof of your disability to the university. Also,

means asking for assistance from others when you need it, and

some schools make exceptions to admission requirements because

making your own decisions about your life.

of a learning or other documented disability. Olivia Emilia is the Information Services Coordinator at Mobility What is the definition of a disability in the

International USA/National Clearinghouse on Disability and Exchange.

United States? The ADA defines a person with a disability as 1) someone with a physical or mental impairment that substantially limits one or more major life activities, 2) someone with a record of such impairment or 3) someone who is regarded or perceived as having such an impairment. This definition covers many disabilities such as learning disorders, diabetes, deafness, cerebral palsy, blindness and major depression, in addition to physical disabilities.

National Clearinghouse on Disability and Exchange (NCDE) www.miusa.org/ncde

Sponsored by the Bureau of Educational and Cultural Affairs of the U.S. Department of State, and administered by Mobility International USA, the NCDE provides advice and resources for advising people with disabilities and consultation for placement organizations on specific issues that may arise. E d u c a t i o n U S A / C O N N E C T I O N S

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Featured Center: Tunis, Tunisia An Interview with an EducationUSA Adviser: A Look at the Administrative Practices EducationUSA Adviser: Territory: Number of Advising Centers in Country: Number of Advisers in Center: Years of Operation: Level of study that advisees pursue: Most popular field of study for advisees: Number of visitors in a year: Services offered at center:

Website:

Arm Chair Tour

Leila Zahmoul Tunisia 1 in Tunis, plus an additional AMIDEAST center in Sousse 1 adviser, plus 1 testing coordinator, 1 receptionist, and occasional volunteers and interns 26 65% graduate, 35% undergraduate Business; Engineering and Sciences Approximately 7,000 Educational advising, scholarship program administration (Fulbright, YES, Middle East Partnership Initiative, Legal & Business Fellowship Program); testing center (iBT TOEFL, GRE, SAT, TOEIC); resource center; Internet access; English Language program. www.amideast.org

With more office space, we have been able to enhance advising services by providing a resource library, a TV to play videos related to U.S. education, and three computer stations with Internet access, which compliment the computer facilities located in the main building. An American Corner (AC) is also incorporated into our office, which is managed by an American college graduate intern who I work with very closely. The AC has a reference library, computers, and a photocopier, plus a TV viewing room where we show American films and documentaries.

AMIDEAST-Tunisia Advising and Testing Center in Tunis.

How does advising work at your Center? We have an open door policy, which fills the center with new faces

Please describe your EducationUSA office.

seeking help, in addition to returning center alumni. Students

The Advising and Testing Center is part of AMIDEAST, an

receive answers to general questions when they drop in and are

American NGO with offices located throughout the MENA region

encouraged to attend the bi-weekly group educational advising ses-

and headquarters in Washington, DC. Our center was part of the

sions. When students attend group advising sessions, we enter

main AMIDEAST-Tunisia building from 1982 until October 2007,

their contact and study information into a student/visitor database,

when we opened a new center adjacent to the building during

which allows for us to follow-up with them on a monthly basis.

Education Week, with the help of the American Ambassador to Tunisia. Center activities are supervised by the AMIDEAST Country

During the summer, American college students intern at the cen-

Director. Since 2001, a second satellite advising office has been

ter and share their experiences in the U.S. and discuss various

functioning in AMIDEAST-Tunisia’s center in Sousse, the third

aspects of what it is like to be an international student. Tunisian

largest city in Tunisia.

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Featured Center: Tunis, Tunisia C O N T I N U E D

F R O M

P A G E

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Student workshop in the advising library.

Workshop in the American Corner of the AMIDEASTTunisia center.

students can relate easily to these students, as most are recent

What are some ways you have been successful in

graduates.

increasing outreach? Our chief focus last year was to increase contacts, as well as to

How do you advise students who need financial assis-

develop and maintain relationships with university representatives

tance to study in the U.S.?

from around the country. We did this by organizing a number of

Last year, we worked closely with a group of 7 high school students

monthly outreach workshops and advertising them regularly at

who were interested in pursuing their undergraduate studies in the

local universities. In the Sousse office, for example, we organize a

U.S. (two were searching for athletic scholarships and the other five

general information session the last Friday of every month. The

were YES alumni). To specifically address ways to finance their edu-

number of students staying in touch with us as well as the number

cation, we created an online Google group administered by our

of U.S. study-related emails, calls, and visits to AMIDEAST offices

interns, which provided students with helpful resources on funding,

in Tunis and Sousse has noticeably increased as a result of these

testing suggestions, and application timelines. In the end, one stu-

outreach efforts.

dent was awarded a full athletic scholarship and two others received partial scholarships to study in the U.S.

How do you advise students about medical education in the United States?

Due to the success of this project and positive feedback from the

Most of the students I advise hope to pursue a medical residency

students, we decided to continue it on a larger scale. The “College

in the U.S. Due to the complexity of the process, I usually set up

Club Project,” as it is now officially called, is designed to reach

one-on-one appointments, during which I explain the steps

students in their second and third years of secondary school and

involved in applying to a U.S. residency program as an internation-

provide them with information on how to obtain scholarships

al student and how competitive, long and laborious this process

from American universities.

Participation in this project has

can be. I always try to put them in contact with other students inter-

grown considerably. The current group consists of 23 students, 18

ested in U.S. medical education so that they can encourage one

of whom are YES alumni.

another throughout the process.

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Special Analysis of the Impact of the Falling Dollar News & Updates

A

lot of media attention has recently been placed on the falling dollar, which seems to have impacted all sectors of the economy, including international education. In particular, reporters have discussed the effect of the weak dollar on study abroad in publications including the Wall Street Journal and USA Today. A recent informal IIE poll indicates the following observations on campuses that have very high study abroad participation:

•

Effects are still not completely known; students have expressed concern, but in general they are still studying abroad.

•

Campuses are doing what they can to keep the program cost down, sometimes switching providers or subsidizing the programs.

•

Campuses have seen a growing shift to non-European destinations, but since it has been happening over the past few years, they cannot say it is only due to the falling dollar.

•

Some campuses have seen a decrease in students enrolling in summer programs to expensive destinations, particularly the UK.

The media has also focused on how the falling dollar has impacted international students studying in the United States. For example, a recent article in the Boston Globe interviews college officials in the Boston area to find out how their schools have been affected. Similarly, an article in the Financial Times reported that rising currency values in Europe and China have created heightened interest in U.S. MBA programs. To gain insight on worldwide trends, Connections asked REACs to share observations from their regions: “The dollar’s decline is accompanied by a rapid increase in inflation due to rising costs of oil, wheat, rice, and corn. Thus, any increases of international students studying in the U.S. from exchange rate advantages may be immediately negated. There’s also widespread fear that things are going to get worse before they get better, even among people in developing countries who have nothing to do with mortgages, credit crunch, stocks and investments.” – Nancy Keteku, REAC Africa "In Eurasia, I see little that can be attributed exclusively to the decline of dollar—or at least, it is difficult to separate from the oil-boom. Over the past few years, government-funded (i.e. oil-funded) scholarships have appeared at a national-level in Azerbaijan and Kazakhstan – and on a sub-national level in Russia, specifically in Tatarstan. The decline of the dollar certainly makes such programs more feasible. On the other hand, the dollar's decline makes it even more difficult for U.S. universities to recruit in the region." – Bram Caplan, REAC, Russia/Eurasia “Many of the economies in this region, and around the world, depend on the U.S. for commerce. As their purchasing power is also affected by U.S. econ-

omy shifts, some families cannot afford the luxury of studying abroad. In addition, basic expenses such as travel have almost doubled; even the cost of the student visa is increasing. While these increases may not represent a constraint for all families, those in the middle and uppermiddle classes are certainly reconsidering their options.” – Nichole Johnson, REAC Mexico, Central America and Caribbean “For the South American countries with strong economies (Brazil, Colombia, Chile and Peru), there is an expectation that the decline of the dollar, along with other factors, will spur student flow to the U.S. institutions. On the other hand, I do not see the decline of the U.S. dollar as having much of an effect on the movement of students from Ecuador (where the U.S. dollar is the national currency), Argentina or Venezuela.” – Rosemarie Arens, REAC South America “Stronger local currencies have had a negative impact on export businesses in East Asia Pacific. Nonetheless, students who depend on family savings for education, which is the majority in EAP, are enjoying the greater spending power. In places such as Hong Kong where the currency is pegged to the dollar, the experience has been that while U.S. options have not become cheaper, tuition at UK, Australian, and Canadian schools are now more expensive.” – Rick O’ Rourke, Co-REAC East Asia and Pacific “In South Central Asia, the fact remains that it takes more of the local currency – be it Indian Rupees or Kazakh Tenge – to purchase one U.S. dollar than it took a year or two ago. The fluctuation of the dollar isn’t making the dream of earning a U.S. degree any more easily affordable. Students from this part of the world continue to worry about the cost of a U.S. education.” – Kathleen Kisting Alam, REAC South Central Asia “Europe is incredibly diverse and the impact of the dollar on U.S. mobility varies as well. One clear trend has been the gains for community colleges. Headlines such as ‘3,100 Euros for Tuition...You Can't Find Cheaper in Paris!’ draw big crowds to advising sessions. You can find country-specific developments in the EducationUSA Trends Report, From Reykjavik to Vladivostok.” – Wesley Teter, REAC Europe “In the Gulf region, publicly-funded students are benefiting from increased resources stemming from the rising price of oil and increased revenue to their governments. (Inflation, however, is rampant so privately financed students have more limited resources to spend on education abroad). North Africans, with economies tied to the euro, are finding a bargain in U.S. education given that their currencies have appreciated significantly against the dollar in the last two to three years.” – Kristen Cammarata, REAC Middle East and North Africa

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Can You Republish Connections Articles? Many advisers have asked whether they can republish Connections articles. The answer is YES, Connections articles may be republished for use in your advising centers. Please be sure to cite the author’s name and state that the article was initially published in

education USA Daniel Obst Sharon Witherell

EducationUSA CONNECTIONS Prepared by the Membership and Publications Division of the Institute of International Education

Executive Editors

Shannon Bishop Editor

Svetlozara Trocheva

EducationUSA Connections journal and include the volume and issue numbers. Please note that some of the articles are intended for advisers and are not designed for direct use by students. However, articles with the heading “Student Resource” or “Field of Study Focus” are intended to be reprinted as handouts for students.

Assistant Editor

For questions, comments or submissions, please contact: Shannon Bishop at [email protected]

Shepherd Laughlin Assistant Editor

Barbara Taff

Additional advising resources and past issues of Connections can be found at: http://educationusaconnections.iienetwork.org.

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