As an International medical graduate, residency can feel like a daunting step for physicians who earned their degrees abroad and want to practice medicine in the U.S. or Canada. To make it easier for you, our guide unpacks the entire process—covering key exams, application strategies, and how to find IMG-friendly programs—to help you get into residency as an IMG. Armed with the information in this guide, you can take the next big step in your medical career and get into your dream residency.
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Who Is Considered an International Medical Graduate?
In the United States: An IMG is anyone who earned a medical degree outside the U.S., regardless of citizenship. U.S. citizens studying abroad are also considered IMGs.
In Canada: An IMG is someone who completed their medical degree outside of Canada. This includes both Canadians who studied abroad and foreign nationals.
International Medical Graduate Residency Requirements in the United States
Education Credential Verification
All IMGs must have their medical school credentials verified through the Educational Commission for Foreign Medical Graduates (ECFMG). Note that Canadian medical graduates must now also receive ECFMG certification to apply to residency programs in the U.S.
The ECFMG issues a certification required for residency applications through the National Resident Matching Program (NRMP).
Visa Requirements
IMGs typically need a J-1 or H-1B visa to train in the U.S.
USMLE Exams
IMGs must pass the three-step United States Medical Licensing Examination (USMLE).
- USMLE Step 1: Tests basic science knowledge
- USMLE Step 2 CK: Focuses on clinical knowledge
- USMLE Step 3: This is the final exam to become a licensed, unsupervised practicing physician
Residency Applications via ERAS
IMGs submit residency applications through the Electronic Residency Application Service (ERAS). IMGs participate in the NRMP Match and may need to apply to more residency programs than U.S. graduates to secure a position. Programs sometimes prioritize U.S. medical graduates, so highlighting your US clinical experience as an IMG and U.S. healthcare experience is crucial.
Some programs offer pre-match contracts outside of the main match process, which can be advantageous for IMGs.
Here's a quick guide on ECFMG certification!
International Medical Graduate Residency Requirements in Canada
MCC Credential Verification
IMGs must create an account on Physicians Apply and submit their documents for verification through the Medical Council of Canada (MCC).
Verified documents include diplomas, transcripts, and proof of clinical experience.
Visa Requirements
IMGs must be a Canadian citizen or a permanent resident of Canada.
Exams Required for Licensure
IMGs must pass the Medical Council of Canada Qualifying Exam (MCCQE) Part 1 to apply for residency programs.
Some programs also require the NAC OSCE, a clinical skills exam.
Residency Application via CaRMS
IMGs apply through the Canadian Resident Matching Service (CaRMS), which offers a competitive two-round match system.
Licensing and Practice
After completing residency, IMGs must apply for full licensure through the relevant provincial medical regulatory body.
Differences Between U.S. and Canadian International Medical Graduate Residency Pathways
6 Proven Tips for a Successful International Medical Graduate Residency Application
A successful international medical graduate residency application requires more than just passing exams—you’ll need a comprehensive strategy on how to prepare for residency applications so that yours really stands out from the crowd!
We’re giving you our best tips to boost your chances of getting matched, including strategies for clinical experience, networking, and finding IMG-friendly residency programs across North America.
1. Gain Hands-On Clinical Experience
Electives and clinical experience are invaluable for a successful international medical graduate residency applications. In the U.S., completing pre-residency fellowships, observerships, externships, or clinical rotations demonstrates your familiarity with the American healthcare system and boosts your credibility with program directors. Similarly, Canadian clinical experience—such as through elective placements—shows that you’re prepared to meet the country’s healthcare standards.
Pro Tip: Look for reputable bridging programs to help you gain local clinical experience. Observerships allow you to shadow physicians, while externships offer more hands-on patient interaction—aim for the latter, where possible, to demonstrate clinical competence.
2. Build a Strong Network and Find Mentors
Networking is an important part of the international medical graduate residency application process to show your connections and a commitment to the local healthcare system. Engaging with current residents, alumni, and program directors can provide valuable insights and open doors. There are three steps IMGs should take to build a strong network:
- Attend Conferences and Networking Events: Medical conferences and professional gatherings are excellent opportunities to connect with residency program representatives.
- Use Alumni Networks: If your medical school has alumni in North America, reach out to them for advice on navigating the application process.
- Join Professional Associations: Groups like the American Medical Association (AMA) or the Medical Council of Canada (MCC) offer events and mentorship programs tailored to IMGs.
Pro Tip: A personal recommendation from a mentor in your target program can significantly improve your chances during the interview process.
Here are some tips for matching to IMG-friendly residency programs!
3. Tailor Your Application to IMG-Friendly Programs
Applying to IMG-friendly residency programs increases your chances of matching. These are programs that have a history of accepting international graduates, either because of their diverse patient populations or institutional policies.
How to Identify IMG-Friendly Programs in the U.S.
- FREIDA Residency Database: The FREIDA platform, managed by the American Medical Association, allows applicants to filter residency programs based on IMG acceptance rates.
- Past Match Data: Analyze match statistics from the National Resident Matching Program (NRMP) to identify programs with higher IMG acceptance. Internal Medicine, Family Medicine, Psychiatry, and Pediatrics tend to have more IMG-friendly programs in the U.S.
- Learn about IMG-friendly states (such as New York, Florida, and Texas) and start your residency search in these areas.
How to Identify IMG-Friendly Programs in Canada
- CanPREPP Program Database: Use the CanPREPP platform to search for IMG-friendly programs in its lists of residency opportunities across Canada.
- Provincial Programs for IMGs: Programs like the Alberta International Medical Graduate Program (AIMG) and provincial bridging programs specifically support IMGs in transitioning to practice.
- Target Specific Specialties: Family Medicine, Psychiatry, and Internal Medicine are more accessible to IMGs in Canada.
Pro Tip: Some provinces, like Nova Scotia, Manitoba, and Saskatchewan, are more IMG-friendly and offer higher chances of matching due to physician shortages in rural areas.
4. Research State or Provincial Regulations
Each state in the U.S. and province in Canada has its own rules governing IMGs, and understanding these regulations is essential to align your residency application strategy.
In the U.S, some states have stricter requirements, such as higher USMLE score thresholds or specific clinical experience prerequisites. Make sure to research the requirements for the states where you plan to apply.
In Canada, some provinces offer direct entry programs for IMGs, but they may also require a return-of-service (ROS) agreement. For example, in Alberta, participants in the AIMG program commit to working in rural or underserved communities for a set period after residency.
Pro Tip: Checking with each state or provincial medical board where you plan to apply early in your application process ensures you meet all regulatory requirements without surprises that could result in significant application delays.
5. Make Strategic Use of ERAS and CaRMS
Using ERAS and CaRMS properly will help you submit a standout application. Both systems allow applicants to tailor their documents to each program and doing so is the key to your success!
In the U.S., apply broadly to IMG-friendly programs to maximize your chances. Make sure your residency personal statements align with each program’s mission and include letters of recommendation from U.S.-based physicians.
In Canada, your application materials should reflect a deep understanding of the province's healthcare needs, and you need to optimize your CaRMS personal letters by customizing each one to reflect the specific program’s mission, highlighting how your experience aligns with their goals, and addressing IMG-specific concerns by showcasing your familiarity with local practices and commitment to the program’s unique needs.
Pro Tip: Prioritize IMG-friendly residency options and customize your applications to ensure each one highlights exactly how your skills and experience will be an asset.
6. Ace Your International Medical Graduate Residency Interview
Interviews are your opportunity to showcase your skills, experience, and fit. The right IMG residency interview prep will leave a lasting impression and prove you are ready to make a phenomenal contribution to medicine in North America:
Understand the Program and Its Culture
Residency programs seek candidates who align with their values and mission. Thoroughly research each program to understand its culture, patient population, and unique goals. Tailor your responses to demonstrate how your background and experiences make you the right fit.
Example: If applying to a program working with underserved communities, highlight your past experience in similar settings or your passion for public health.
Prepare and Practice Common Questions
While every interview is unique, many residency interview questions are similar or have overlapping themes. Prepare responses to questions like:
- Tell me about yourself.
- Why did you apply to this program?
- Describe a time you dealt with a challenging situation in clinical practice.
Pro Tip: When possible, make sure your answers circle back to experiences and knowledge that you will be able to capably apply in local healthcare settings.
Demonstrate Your Clinical and Communication Skills
Since programs are looking for residents who can adapt to their healthcare system, showcase your clinical experience in the U.S. or Canada and emphasize your ability to work in diverse teams. Programs also value strong communication skills, so be clear, concise, and engaging in your responses.
Example: Highlight cases where you successfully collaborated with interdisciplinary teams or communicated effectively with patients from various backgrounds.
Here's why clinical experience is so important for IMGs
Ask Insightful Questions
Your questions reflect your level of preparation and interest in the program. Avoid general questions like “What’s the call schedule?” Instead, ask thoughtful, program-specific questions, like “How does the program support residents interested in leadership roles?" or "What do you think sets this program apart from others?"
Pro Tip: Before the interview, review the program’s website, mission statement, and recent achievements to help you draft highly specific questions. For example, if the program emphasizes research or community outreach, ask how residents are supported in these areas or about recent projects they've been involved in.
Address Challenges Unique to IMGs
Some programs may have concerns about IMGs adjusting to the local healthcare system. Use the interview as an opportunity to address this proactively. Mention any observerships, externships, or bridging programs you’ve completed and describe how these experiences prepared you for the residency.
Example: “During my externship in New York, I became familiar with the electronic medical records system and developed strong communication skills with English-speaking patients.”
Master Virtual Interviews
Many programs now conduct video interviews online, so you need to be comfortable with virtual platforms. Test your audio, video, and internet connection beforehand. Maintain eye contact by looking directly at the camera, and ensure your background is neat and professional.
Pro Tip: Dress as you would for an in-person interview to make a polished impression.
Follow Up with a Thank-You Email
Within 24 hours of your interview, send a brief, personalized thank-you email to the program director or interviewers. Mention a specific detail from your conversation to make your message stand out and reinforce your interest in the program.
Example: "Thank you for taking the time to speak with me today. I particularly enjoyed learning about the mentorship opportunities you offer to residents."
1. HOW CAN AN INTERNATIONAL MEDICAL GRADUATE APPLY FOR RESIDENCY IN THE U.S.?
To apply for U.S. residency, IMGs must obtain Educational Commission for Foreign Medical Graduates (ECFMG) certification, pass the USMLE exams, and submit applications through the Electronic Residency Application Service (ERAS).
2. HOW CAN INTERNATIONAL MEDICAL GRADUATES GET RESIDENCY IN CANADA?
IMGs can apply for residency in Canada through the Canadian Resident Matching Service (CaRMS). They must pass the Medical Council of Canada Qualifying Examination (MCCQE) Part 1 and may need to complete the NAC OSCE depending on program requirements.
3. DO INTERNATIONAL MEDICAL GRADUATES NEED A VISA TO DO RESIDENCY IN THE U.S. OR CANADA?
IMGs need a visa (J-1 or H-1B) for U.S. residency. In Canada, IMGs must be Canadian citizens or permanent residents to apply for residency positions, as most programs do not offer visa sponsorship
4. WHAT EXAMS DO INTERNATIONAL MEDICAL GRADUATES NEED FOR RESIDENCY IN THE U.S. AND CANADA?
For U.S. residency, IMGs must pass the USMLE Step 1, Step 2 CK, and Step 3 exams. In Canada, IMGs must pass the MCCQE Part 1, and some programs also require the NAC OSCE exam.
5. WHAT ARE IMG-FRIENDLY RESIDENCY PROGRAMS IN THE U.S. AND CANADA?
IMG-friendly residency programs are those with a history of accepting international medical graduates. In the U.S., programs in specialties like Internal Medicine and Family Medicine often accept IMGs. In Canada, certain provinces, like Nova Scotia and Alberta, have programs designed specifically to support IMGs.
6. HOW CAN INTERNATIONAL MEDICAL GRADUATES IMPROVE THEIR CHANCES OF MATCHING FOR RESIDENCY IN THE U.S. OR CANADA?
To boost their chances, IMGs should gain hands-on clinical experience in the U.S. or Canada, apply to IMG-friendly programs, network with healthcare professionals, and tailor their applications to showcase relevant clinical and communication skills.
7. HOW LONG DOES IT TAKE FOR AN INTERNATIONAL MEDICAL GRADUATE TO GET RESIDENCY?
The timeline for an IMG to secure residency can vary, but it typically takes 1 to 3 years to complete all required exams, credential verifications, and the application process. IMGs should also account for any additional time spent gaining clinical experience and networking, as these are imperative for a successful match.
8. WHAT ARE THE CHALLENGES INTERNATIONAL MEDICAL GRADUATES FACE IN SECURING RESIDENCY?
IMGs often face challenges such as higher competition for residency spots compared to domestic graduates and the need for U.S. or Canadian clinical experience. Additionally, some residency programs may prioritize local graduates, so IMGs should strategically target programs with a history of accepting international applicants.
To your success,
your friends at BeMo
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4 Comments
Bénita Uwanziga • 06/14/2021 11:02
Thank you so much .. A whole package of the Information I needed right now!
ReplyBhawna sharma • 01/25/2022 19:11
A complete information about CARMS which j had been looking for since so long . Thanks . I need some information for the fellowship program in the sub speciality of gynaecology and obstetrics.please provide if possible
ReplySahar Abuzakaly • 05/13/2022 01:06
Many thanks for all of this information!. I’ve a question, I’m now a graduate and haven’t taken any of my USMLE exams+ no research experience and willing to be a resident of pediatrics in US ,if I have to choose between these 2 : 1- Be a pediatric resident in my university hospital and obtain a master’s degree in pediatrics in hope to increase my chances ( with the known time limitations & exhaustion of residency (24hr-shifts every other day)) Or 2- choose an academic teaching pathway ( like biochemistry) with more time to study and do research if possible. Your advice is of supreme importance as I am at a loss of mind ?.
ReplyLc • 11/03/2022 04:43
Is there a way (for someone who finished med school and residency abroad) to work in Canada or US without taking any extra exams? Not necessarily as a doctor, any job where one can have an advantage for having a medical degree is welcome...
Reply