An Announcement Regarding Fraudulent Letters of Recommendation

The submission of fraudulent letters of recommendation by applicants to ECFMG continues to be of great concern.
In July 2007, The ECFMG Reporter (Issue 116) contained important information on the issue of fraudulent letters of recommendation. However, since that time, additional instances of fraudulent letters of recommendation have come to ECFMG’s attention.
The submission to ECFMG of fraudulent letters of recommendation constitutes irregular behavior as defined by ECFMG.

Examples of fraudulent letters of recommendation include, but are not limited to:

• writing a letter of recommendation for yourself and signing another person’s name to make the letter appear to be authored by another person;
• altering parts of an authentic letter of recommendation given to you by the letter writer; and
• signing another person’s name to a letter of recommendation, even if you believe that person approves of your signing the letter on his/her behalf.

The submission of fraudulent letters of recommendation is a very serious matter. Allegations of submission of fraudulent letters of recommendation, along with all other allegations of irregular behavior, are reviewed by the ECFMG Medical Education Credentials Committee, a standing committee of the ECFMG Board of Trustees. If the Committee determines an individual has engaged in irregular behavior:

• a permanent annotation will be included in his or her ECFMG Status Reports and Certification Verification Service (CVS) Reports;
• additional information explaining the basis for the finding of irregular behavior and the resulting action will accompany every ECFMG Status Report and CVS Report and may also be provided to legitimately interested entities; and
• the decision will be reported to the Federation of State Medical Boards’ Board Action Data Bank, state medical licensing authorities, directors of graduate medical education programs, and to any other organization or individual who, in the judgment of ECFMG, has a legitimate interest in such information.

Furthermore, ECFMG may:

• bar an individual from exams; and
• withhold or revoke a Standard ECFMG Certificate.

In recent years, the ECFMG Medical Education Credentials Committee has made a determination of irregular behavior in 14 cases based upon the submission of fraudulent letters of recommendation. In all but one of these cases, the physician’s Standard ECFMG Certificate was revoked. Since these individuals are no longer certified by ECFMG, they are not eligible to enter an accredited residency program in the United States and are not eligible to take USMLE Step 3, both of which require ECFMG Certification.
In June 2006, ECFMG instituted the “original document” policy requiring all international medical students and graduates participating in the Electronic Residency Application Service (ERAS®) to submit original letters of recommendation. This policy is consistent with U.S. medical school practices. These letters must be written on official letterhead and signed by the letter writer in an ink color other than black. For enhanced authentication, applicants are advised to request the letter writer to affix an institutional seal to the letter of recommendation.
ECFMG makes a visual inspection of the letters when they are received to determine if they are originals or copies. If ECFMG determines that a letter of recommendation is a copy, the document will be stamped to indicate that it is a copy before it is made available to program directors. Refer to the letter of recommendation requirements on the ERAS Support Services at ECFMG website for more information on this policy.
Directors of residency and fellowship programs are responsible for verifying the authenticity of letters of recommendation. In most of the recent cases reviewed by the ECFMG Medical Education Credentials Committee, the fraudulent letters of recommendation were detected by program directors attempting to verify a letter’s authenticity.
For detailed information on ERAS policies, visit the website of the Association of American Medical Colleges (AAMC) at www.aamc.org.

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