International Medical Graduate: The Ultimate Guide

IMG Friendly Residency Programs

According to the most recent NRMP Main Residency Match, the following are the most IMG friendly residency programs in the US:

Working on your residency application? Check out our tips on avoiding red flags:

How Do I Match as an International Medical Graduate (IMG)?

How the Match Works

Want to know how to get into residency programs as an IMG? First, you will need to know how residency matching works. The matching process in both Canada and the United States is facilitated through the use of a computer algorithm, provided by residency match services. Each applicant submits a residency Rank Order List (ROL) of preferred programs, while each program director submits a ROL of preferred candidates. The algorithm then matches the applicant’s ranked programs with program directors’ ranked candidates.

In Canada, these lists are entered into the Canadian Resident Matching Service (CaRMS). CaRMS is a national organization that provides an electronic application and computer matching service for entry into residency positions throughout Canada. In the United States, they are entered into the National Residency Match Program (NRMP), which performs The Match. The Electronic Residency Application Service (ERAS) is used by most American programs for residency matching.

To participate in the residency match in the US and Canada as an IMG, you must first learn what constitutes an IMG in both countries. Let’s start with the US.

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Try our Residency Match Calculator to help you strategize what programs and specialties will be most fitting for you!

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IMGs in the US

International medical graduates aiming to match in America are divided into 2 main groups: US IMGs and Non-US IMGs.

US IMGs are citizens of the United States who graduated from international medical schools. Non-US IMGs are non-US citizens who graduated from international medical schools. Non-US citizens who graduate from US medical schools or medical schools in Canada are not considered IMGs. Essentially, the Unites States considers anyone who graduates from a non-US MD or DO school an international medical graduate, regardless of their citizenship. This means that if you are a US citizen educated in one of the Caribbean medical schools, for example, you are a US IMG, while a student with French citizenship, let's say, who graduated from a medical school in the US is not an IMG.

It's important to note that Canadian citizens are also not considered IMGs in the US, even if they attended Canadian medical schools. Canadians are eligible to apply for residency via the Canadian Resident Matching Service and the US Electronic Residency Application System at the same time. If you are a Canadian citizen matched to a US residency spot, you will be required to apply to the Educational Commission for Foreign Medical Graduates (ECFMG) and obtain a J-1 visa to be able to train and work in the US. We will outline this process later in this blog.

IMGs in Canada

In Canada, on the other hand, your citizenship or residency status directly affects your chances to participate in CaRMS. You must be a Canadian citizen or a permanent resident of Canada to be eligible for the match. While there are some Canadian medical schools accept US students and international applicants, the latter cannot participate in the match unless they become Canadian permanent residents or citizens. Otherwise, any Canadian citizen who graduated from an international medical school (including Canadian-friendly US med schools) is considered an IMG.

So, if you are a Canadian citizen who graduated medical school outside Canada or you are a Canadian medical school graduate without Canadian citizenship, you will be considered an IMG and will not be able to participate in the Canadian residency match. You can, however, apply to residency programs in the US.

Eligibility Requirements for IMGs in the US

The Match is a system used to match students with US residency programs. Although not every program uses The Match, most do. Programs that choose to participate are required to register each position and attempt to fill them to ensure a fair process. Before IMGs can start applying for residency positions, they must meet a set of requirements.

As we already discussed, US medical schools have their own definition of international medical graduates. The location and accreditation of the medical school attended determines whether the graduate is an IMG, not the citizenship of the graduate. The Educational Commission for Foreign Medical Graduates (ECFMG) assesses whether IMGs are ready to enter residency programs in the United States. You must be certified through one of the ECFMG pathways before you can take the USMLE or start a graduate medical education program, since there are no residency programs that don't require ECFMG certification. The ECFMG coordinates the ERAS application process for international medical graduates.

You will need to meet several levels of requirements as an IMG before you are eligible for the US residency match. These requirements include:

• ECFMG certification
• US state medical board requirements
• Specific residency program requirements
• US visa requirements

Here's some tips on matching to IMG friendly residency programs:

#1: Certification with ECFMG

The certification process starts when you apply to ECFMG for a USMLE/ECFMG identification number. As soon as you get this number, you can use it to complete the application for ECFMG certification. Once you submit your application for certification, you may apply for examination. As one of the requirements of certification is the verification of your medical school diploma, you cannot complete the entire certification process until you have graduated. With this said, you can apply for the required examinations as soon as you meet the examination eligibility requirements. All of the required examinations are offered throughout the year.

#2: State-specific requirements

The Federation of State Medical Boards (FSMB) publishes US state-specific requirements for medical licensure, including:

1. Minimum postgraduate training required
2. Number of attempts at licensing examination allowed
3. Time limits for completion of licensing examination sequence needed for license eligibility

The FSMB updates state-specific information for residencies. You can use this site to find out if you can get a license in a specific state during residency and to identify the most IMG friendly states in the US. Some states, such as California, have a list of recognized international medical schools that are eligible for licensure in the state. Some states have restrictions on the number of USMLE attempts allowed.

Make sure to check the FSMB website in advance as you don't want to waste your time and money applying in states that limit training permits or recognize fewer international medical schools than the full list of World Directory of Medical Schools. It is crucial to verify your eligibility within each US state and each program before you apply.

You should also take the time to research the most IMG friendly residency programs or IMG friendly hospitals in different US states.

#3: Residency Program Requirements

Program requirements for each residency position are most often listed on their websites. These may include medical school graduation year, types of visas accepted, or how many USMLE attempts are allowed. Make sure that you understand your program’s residency requirements before applying.

You can find the descriptions of most US residency programs on the following online directories. These include:

• The Fellowship and Residency Electronic Interactive Database Access (FREIDA) is the online directory of graduate medical education programs sponsored by the American Medical Association (AMA)
• The Accreditation Council on Graduate Medical Education (ACGME) also offers a residency directory
• The American Academy of Family Physicians (AAFP) offers an online family medicine residency directory 

Each medical specialty has specific information about individual programs, as well as any general or special requirements for application including whether they admit IMGs. You may also get some insight as to what residency program directors look for in applicants to help you prepare your application.

Application deadlines vary among the programs. Make sure you confirm your program’s deadlines.

#4: Visa Requirements 

In order to participate in American graduate medical programs, international medical graduates who are not citizens or permanent residents must obtain the appropriate visa. The two most common visas are the H1-B (Temporary Worker) or the J-1 (Exchange Visitor). Some institutions will sponsor the visa for residents in the residency program, so it would be wise to check with your program.

The ECFMG is also authorized by the US Department of State to sponsor foreign national physicians for the J-1 visa. Learn more about your visa application process from your residency program, the American embassy or consulate in your country of residence, or the US Citizenship and Immigration Services.

Need help with your residency applications? Here's what our students say about us:

Eligibility Requirements for IMGs in Canada

The Medical Council of Canada (MCC) provides requirements for the residency match process. Make sure to check these requirements on their website before you begin your applications. If you are an IMG wishing to apply for residency in Canada, these are the standard eligibility requirements:

1. You are a current student or graduate from a school listed in the World Directory of Medical Schools, OR your medical school must be accredited by the Committee on Accreditation of Canadian Medical Schools (CACMS) or the Liaison Committee on Medical Education (LCME) in the U.S., OR your medical school must be accredited as a U.S. School of Osteopathic Medicine.
2. Written and passed or be scheduled to write the National Assessment Collaboration (NAC OSCE) examination.
3. Written and passed or be scheduled to write the Medical Council of Canada Qualifying Exam Part I (MCCQE Part I). This examination assesses the critical medical knowledge and clinical decision-making ability of a candidate at a level expected of a medical student who is completing his or her medical degree in Canada.
4. Must be a Canadian citizen or a permanent resident of Canada. Visa holders are not eligible.

You can choose to take the MCCQE Part 1 and NAC OSCE as an IMG in the order that you prefer. You must also remember to write the examinations before the programs’ deadlines. Please check with your program when the examination results must be submitted and schedule your exam accordingly. You can find important timeline information for your application cycle on the MCC website. Please be aware that the United States Medical Licensing Examination (USMLE) cannot substitute any of these exams.

Need to write the MCCQE? Here's how a prep course can help:

Provincial requirements

The above-mentioned list includes just the basic requirements that would allow IMGs to participate in the CaRMS matching process. The requirements of MCC are just one set of criteria, but you must research the requirements of each Canadian province separately in order to apply for positions in those provinces. As an international medical graduate, you may have to take additional steps to verify your medical degree, complete additional examinations, or enter into a service agreement that commits you to practice in a particular area for a specific amount of time. Take into account that meeting certain provincial eligibility requirements for IMGs can be extremely challenging.

You can find help discerning all the provincial requirements by visiting the CaRMS official website where you will find the provincial criteria section. Requirements listed under each province in this section will apply to all programs within that province. Ensure you have read the information provided under the provincial restrictions to meet all the necessary requirements when applying for the programs of your choice. A list of programs with descriptions is also available on the CaRMS website. Each program will indicate what documents are required, which exams need to be passed, and which provincial assessments are preferred. When studying each program, be sure to check both the program’s list of requirements and the criteria of the province in which the program is located.

How to Stand Out as an IMG in Your Residency Application

Competition is fierce for IMGs. Each year, thousands of applicants compete for few positions. In recent years, US IMGs matched at an approximate 61.4% rate while non-US IMGs matched at a rate of 58.1%.

In Canada, IMGs matched at an approximate 33.2% rate, and US graduates matched at an 63.1% match rate, compared to Canadian medical graduates who matched at a rate of 96.3%

Rates of IMGs matched in US and Canada

According to a study by the NRMP, IMGs that matched to their preferred specialty are most likely to:

1. Rank more programs within their preferred specialty
2. Have higher USMLE Step 1 and 2 scores
3. Be US citizens

When considering how many residency programs to apply to, remember that each application demands a high level of research and preparation. The quality of an application is the most important aspect, so it's better to send fewer high-quality applications instead of more low-quality applications. The Association of American Medical Colleges (AAMC) keeps records of the average number of residency applications per student for different specialties. Some of the most competitive fields, including family medicine residency, psychiatry, internal medicine residency, anesthesiology, and pediatrics, see more than 70 applications from one candidate. So, with all those applications, how can your application stand out? Keep in mind that your preparation for residency applications should start long before you fill out the ERAS or CaRMS application forms. Gaining relevant experiences, developing critical skills, and forming strong relationships with mentors takes time.

Now, let's review our tips to help you craft the best application as an IMG applicant!

#1: Gain clinical experience where you want to practice

As an international medical graduate, you should aim to gain electives and clinical experience in the country to which you're applying. This is important for making your application stand out and for convincing program directors that you’ve taken the necessary steps to transition effectively from a foreign medical graduate to an effective physician in a new country. In addition to gaining first-hand experiences in Canadian or US healthcare systems, this clinical experience will also allow you to secure ERAS letters of recommendation or CaRMS reference letter from faculty members who supervised you and who are familiar with the expectations of US or Canadian residency programs. It is a good idea to consider setting up a clinical externship or enroll in an elective program that can provide valuable hands-on experience in the American or Canadian medical system. If you are looking at urban vs rural residency programs, note that many programs value residents who want to work in rural or underserved areas in both countries.

If you are currently a medical student, many medical schools offer opportunities for visiting students and clinical away electives. Some programs are free, but most require a fee. Some Canadian medical schools that offer visiting student programs are the University of Toronto med school, Queen’s university med school, UBC medical school and the University of Alberta medical school.

#2: Participate in observerships

If you are no longer in medical school, your chances of obtaining clinical experience in the US is limited, but not impossible. Your best option is to participate in observerships. Similar to physician shadowing, observerships will provide you with an opportunity to learn about the healthcare system in the country you’re applying, make connections, and increase your overall knowledge. 

In some Canadian provinces, IMGs may apply for a clinical observership permit. For example, Nova Scotia issues clinical observership permits to students who were trained outside of Canada and do not yet meet requirements for a license to practice medicine in Nova Scotia. The permits allows you to observe, learn, and gain insight into the practice of medicine in Nova Scotia under the supervision of practicing doctors in hospitals and medical practices. This will be helpful in preparation for your MCC licensing examinations and skill assessment. Keep in mind that the observership permit is not a license to practice medicine, nor is it considered as training or work experience.

If you want more options for gaining experience as an IMG, you can look at how to apply to pre-residency fellowships as an IMG.

#3: Gain research experience

Another way to improve your residency applications, especially for programs that focus on academic progress and training future researchers, is to gain research experience. Securing a position as a research assistant will help set you apart from other IMGs as most programs highly value US or Canadian research experience. Try to gain a position where you’ll be testing hypotheses, analyzing results, and preparing reports. Make sure that you form a good bond early on with your research mentor in order to secure an excellent letter of recommendation. If you participated in any premed research opportunities or clinical research as a premed, these are excellent experiences to showcase in your residency application, especially if they were gained in Canada or the US.

Want tips on getting clinical experience? Take a look at this infographic:

#4: Strengthen your extracurriculars

Extracurricular activities matter for one simple reason: every strong candidate has them. You will not be a program director’s top choice if you have nothing to put in the CaRMS or ERAS experiences section. Clinical experience, volunteering, teaching, and research are great experiences to possess. These activities can make you stand out above other applicants and can be the difference between simply matching and matching with your preferred program. The directors of residency programs will want to see that you are passionate about medicine and your specialty choice and that you’re constantly learning and growing as a person and future physician. It’s important to note that not all extracurriculars have to be related to medicine. Showing dedication and a long-term time commitment to activities that are important to you are just as meaningful. For example, commitment to a particular sport, a musical instrument, or even a type of dance. Now, this doesn’t mean that you have to join every single student-run clinic or apply for every leadership program. Make sure that you are only participating in activities that you actually enjoy and are significant to your growth and development. 

#5: Demonstrate core competencies

As you craft your application components, keep in mind that your application should demonstrate the qualities and characteristics expected of all physicians in the US and Canada. It is crucial for IMGs to familiarize themselves with Canadian and US guidelines that dictate the expected behavior and abilities of future physicians.

For Canadian applicants, the CanMEDs framework is a good reference for any future physician, as it identifies the qualities and abilities physicians require to develop in order to perform their jobs well. These qualities and abilities can be grouped into these seven roles: medical expert (primary role), professional, communicator, collaborator, leader, health advocate, scholar. When preparing your personal statement, residency CV, or if you are practicing for an interview, try to relate your extracurricular activities and experiences to these seven roles.

The Association of American Medical Colleges or AAMC competencies is another framework that can help US residency applicants choose and highlight appropriate extracurricular activities. Fifteen abilities and skills are grouped into three categories: pre-professional competencies, thinking and reasoning competencies, and science competencies. These 15 core competencies can help you organize your developed skills and abilities and connect them with your program’s expectations. So when you write your personal statement or look for experiences to highlight in your CV, reference these frameworks to choose the best activities that demonstrate your suitability for your chosen specialty.

#6: Craft an eye-catching personal statement

For most residency programs, the personal statement is a key factor in their choice of candidates. It’s important to demonstrate reflection in your personal statement and write concisely. You’ll have to write a separate residency personal statement for each specialty you apply to, but not for each program, so it's important to adhere to any word or character count stated in the program-specific instructions. Let’s examine some of the things you should keep in mind when preparing your personal statement for each program.

IMGs looking to match in Canada and the United States can find helpful information in program directories. First, be sure to study the description of the program you’re applying to as it will give you some clues as to what you should emphasize in your personal statement. Read between the lines – the description may give direct or indirect indications as to what this program likes to see in their residency candidates. Does the program stress public service or research? Does it seem to highlight specific qualities like interpersonal skills, or academic prowess? Perhaps the description questions candidates’ level of commitment, ability to handle pressure, and communication skills? Decide accordingly what the main message of this description is and what kind of impression you want to make. Create a strong connection between your candidacy and the program.

Next, your statement needs to answer why you want to pursue a particular specialty. Remember, your personal statement is not a recitation of your CV, instead, it's an opportunity to discuss who you are as a person, how your experiences have led you to apply, and why you are a suitable candidate for the position. You'll need a strong, unique introduction, evidence filled body paragraphs, and a conclusion that ties everything together and leaves program directors wanting to learn more about you.

Finally, your personal statement should be free from grammatical errors and spelling mistakes and should be reviewed, ideally by a professional, multiple times, in order to get it just right. Have a look at successful residency personal statement examples and IMG personal statement examples for residency to help you craft your own effective essay.

#7: Obtain a Strong MSPE

Your Medical Student Performance Evaluation (MSPE) or Medical Student Performance Record (if you are applying in Canada) showcase an objective review of your suitability for the medical profession and the specialty that you are choosing to pursue. MSPEs are typically created by deans, faculty, and administrators of your medical school. MSPEs are meant to be objective evaluations of your performance as a medical student that help residency programs determine if you’re a good fit.

If your medical school does not traditionally offer MSPEs to their students, you must work hard to obtain this important evaluation. Firstly, you should approach the dean and faculty of your medical school to ask for an MSPE no later than the summer before your ERAS or CaRMS application is due. The more time you give yourself, the better. Explain that you need this assessment in order to match in Canada or the United States. Secondly, explain the format and requirements of the MSPE. Outline the purpose of this evaluation and ask if a similar document can be produced by your medical school. While the format does not have to be exact, the closer it is to the AAMC format or the CaRMS format, the better. It would be ideal if you can sit down with your committee to make sure all the necessary elements of the MSPE/MSPR are included. You can also ask them to emphasize specific rotations, electives, or publications that you are most proud of.

Step-By-Step Guide to Preparing for Your Residency Interview

The residency interview is your chance to assess your chosen programs personally. Even though you’re the interviewee, what’s great about residency interviews is that you also can play interviewer to decide whether or not you want to become a resident in a particular program. During your interview, keep tabs on how compatible you are with the program, how comfortable you feel, and how well the program meets your desired goals. You’ll want to assess the program’s strengths and weaknesses so that you will be able to structure a well-founded ranked list of your chosen programs. At the same time, your interviewers will be trying to assess your compatibility with their program. During your interview, faculty and residents will try to understand whether you would be a welcome addition to their program. In short, the residency interview is a delicate and complicated interaction that tests both the candidate and the program.

The only way to ace your residency interview is to prepare effectively in advance. Follow these tips below to help get you there:

1. Determine your interview format

Review the information you’ve received from the residency program to determine your interview format. You could have a panel interview, traditional one-on-one interview, video interview or multiple mini interview (MMI). The interview format will greatly affect your IMG residency interview prep.

2. Research programs

It’s essential to do your research before the interview so you know as much about the program as possible. Go into the program’s website to review their mission statement, core values, accomplishments and history. You will almost certainly be asked the “why our program” residency interview question, so you need to develop your own suitable answer to this question. Find out what is important to them, and then highlight your relevant experiences and values that make you a suitable applicant.

3. Reflect on you

Know yourself. Be confident and aware of what you have to offer. You have acquired a wide range of skills and experiences throughout your education and your training. Be sure that you can articulate experiences you've had, answer why they were important, and what you've learned from them. It is essential to be able to connect your skills to the programs’ expectations.

4. Highlight key qualities and desirable personality traits

Highlight traits sought by interviewers such as drive, motivation, communication skills, determination, confidence, reliability, honesty/integrity, dedication, analytical skills, listening skills. You should be highlighting some of these qualities in your personal statement but you should also discuss them in your interview.

5. Practice with residency mock interviews

ERAS interview prep is a long and challenging process. You need to be prepared to answer common residency interview questions such as "tell me about yourself” and "why our program" effectively as these are not easy questions to answer on the spot. For this reason, it's essential that you practice with questions that you're likely to encounter so that you can formulate a strong response early on.

In addition to preparing with practice questions, it is essential to participate in full-length mock interviews in the format of your interview. For example, if you have a MMI, it’s a good idea to participate in a realistic MMI interview in order to understand different types of MMI questions, practice your pace, and receive personalized feedback to strengthen your answers and eliminate any weaknesses or red flag responses.

As you continue to participate in mocks, make sure to check out MMI questions to get you started and if you're applying to CaRMS, check out common CaRMS interview questions and CaRMS interview prep tips. You can even review medical school interview questions to practice answering some of the most common questions faced by future medical professionals. 

6. Gather a list of questions to ask your interviewers

It’s a good idea to have some interesting questions prepared ahead of time to let your interviewers know that you’ve really given some thought to the qualities of their particular program. Prepare specific questions about the program, location, residents, and school and ask them at the end of your interview. Try to stand out with your questions. Your interviewers are most likely tired of answering the same questions (just like you). You will make a more lasting impression if you come up with memorable inquiries, in addition to those that will help you rank the program effectively.

7. Rehearse

Once you have your main talking points for answering residency interview questions, you need to rehearse. Practice by saying your answers out loud in front of a mirror, or if you can, record yourself. This will help you look for any nervous or unfavorable behaviors you may be exhibiting such as playing with your hair or pacing. You don't want to memorize your answers, but you want to ensure you’re hitting the most important points during your responses and that you feel comfortable and confident. If you want professional feedback on your interview performance, you can ask an IMG residency consultant for interview prep help.

8. Send thank-you letters

Remember to send thank-you letters to program directors within 48 hours after your interview. Include your name, interview date, and ideally, the names of your interviewers. Sending thank you letters after an interview is a nice way to leave a good impression!

Preparing for your interview? Check out sample interview questions and answers:

FAQs

To your success,

your friends at BeMo

BeMo Academic Consulting

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