Thousands of students who have completed MBBS are unable to appear for any foreign licensing examination as the colleges they have graduated from have not initiated the process for an "ECFMG sponsor note" in the World Directory of Medical Schools. This is a formal note on a medical college's listing in the world directory indicating that it meets standards set by Educational Commission for Foreign Medical Graduates (ECFMG).

The directory aims to list all medical schools which have been recognised by the local govt or ministry concerned, globally. However, colleges listed here might not have sponsor notes that make their students eligible for ECFMG certification, a credential evaluation agency. Colleges can apply electronically for credential verification only after their first batch of graduates, or roughly five years after the first batch is admitted.

Usually, colleges start the process when their first batch starts the 12-month compulsory rotating medical internship. However, many students have discovered after MBBS graduation that their colleges have not got ECFMG sponsor notes. Most students who join colleges don't check whether their college has ECFMG sponsor notes till after graduation when they want to sit for USMLE (United States Medical Licensing Examination), UK's PLAB (Professional and Linguistic Assessments Board) or other licensing exams.

Many graduates of Kalpana Chawla Medical College in Karnal, Haryana, discovered that their college did not have ECFMG sponsor notes though it admitted its first batch in 2017. Some at AIIMS have not got ECFMG sponsor notes.

In response to an RTI query , National Medical Commission (NMC) stated that "as and when any information or documents to update ECFMG sponsor note in respect of Indian medical colleges is asked by ECFMG, the same is provided to ECFMG immediately after due process and approval of competent authority".

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NMC's response on June 30 stated the submission of information to ECFMG to update sponsor notes on the world directory list was under process in NMC for several colleges.

There was no response from NMC and Union health ministry to TOI's queries on whether it was mandated that all Indian medical colleges must apply to ECFMG sponsor notes on time, and on students' complaints on the issue.