Student Loans

Because the Education Department has failed to ensure that foreign medical schools meet U.S. standards before letting them participate in the student loan program, an estimated $118 million in loans between 1986 and 1991 went to students attending foreign medical schools whose standards may be questionable. This occurred for several reasons. First, Education's standards for assessing these schools fall short. In particular, Education does little to assess the clinical training of foreign medical students. Second, Education has done little to enforce the few standards it has in place. Third, Education has no way of preventing students who attend unapproved schools from receiving loans. State medical boards cannot obtain information they need to evaluate the education of foreign-trained doctors before licensing them, mainly because of a lack of resources but also because schools refuse to cooperate. As a result, unqualified physicians may be entering the mainstream of American medicine. Many states have tried to compensate for the lack of information on foreign schools by raising the postgraduate training requirements for graduates of these schools. At the same time, foreign medical associations and other groups are putting increasing pressures on states to treat these graduates the same as their U.S.-trained counterparts.

GAO found that: (1) Education has not met statutory requirements to ensure that foreign medical schools are comparable to U.S. medical schools before authorizing their participation in the student loan program; (2) Education does not assess the adequacy of foreign medical schools' clinical training programs or the affiliations of the clinical facilities to which they send their students for training; (3) Education made $118 million in loans between 1986 and 1991 to students attending foreign medical schools, but it did not ensure that these schools met U.S. standards; (4) Education does not have adequate procedures to ensure that students attending unapproved schools are excluded from the student loan program; (5) Education relies predominantly on information supplied by foreign medical schools and does not conduct site visits to verify information on the quality of education at these schools; (6) foreign-trained medical students tend to score lower than U.S.-trained medical students on qualifying examinations; (7) Education has approved foreign medical schools that state medical boards have disapproved; (8) state medical boards often do not have the information they need to evaluate the quality of education at foreign medical schools because they lack sufficient resources and foreign schools are not required to cooperate with them; and (9) states have compensated for the lack of information on foreign schools by raising postgraduate training requirements for foreign medical school graduates, but they are under increasing pressure to treat all license applicants equally.

Recommendations

Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.

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