Chicago ? The number of foreign medical school graduates seeking training in the United States has plummeted since the start of an expensive new test that requires them to demonstrate their English skills, a study found.

The number of foreign graduates taking the exam, required of applicants for residencies and fellowships, dropped by more than half between 1997 and 2001, from 36,231 to 16,828, researchers found.

The decline coincided with a requirement instituted in 1998 that they pass a clinical skills assessment, during which they must communicate with fake “patients” in English and are scored on the staged encounters.

The study’s authors suggest that foreign students may be dissuaded by the prospect of having their English evaluated. The authors also cited the $1,200 cost of the test and the expense of traveling to Philadelphia, the sole examination site.

Dr. Alex Yadao, president of the American College of International Physicians, said the exam and other required tests, as well as the travel expenses, can amount to several thousand dollars.

“Foreign doctors cannot afford that,” he said.

The study, conducted by the Educational Commission for Foreign Medical Graduates, appears in today’s Journal of the American Medical Assn.

The study involved foreigners who applied for 2001 programs that began before the Sept. 11 terrorist attacks. Newer figures suggest that foreign applications have surged since Sept. 11, said the lead author, Dr. Gerald Whelan.

The longer-term downward trend “could have a significant impact on the overall graduate medical education population and the resulting U.S. medical work force,” the researchers said, because foreign medical graduates consistently represent about one-fourth of both groups.

A similar clinical-skills test proposed for U.S. medical students has prompted objections from the AMA and other groups concerned about the exam’s cost and effectiveness.