How to choose an International Medical School US Residency
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How to Choose an International Medical School for US Residency (2026 Guide)

February 27, 2026

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Key Factors When Choosing an International Medical School for U.S. Residency

Data reflect current NRMP match statistics through 2025 and ECFMG certification policies effective through the 2025–2026 application cycle.

Last Updated: March 2026 How to Choose an International Medical School for US Residency

The question of how to choose an international medical school for US residency is among the most consequential decisions a prospective physician can make—one that influences specialty options, geographic flexibility, and long-term career trajectory.

This evidence-based guide is designed for U.S. citizens, permanent residents, and international students considering medical education abroad with the goal of practicing medicine in the United States. Unlike promotional rankings or anecdotal advice, this framework synthesizes peer-reviewed literature, NRMP match data, and ECFMG certification requirements to provide a structured decision-making approach.

International medical graduates (IMGs) constitute roughly one-quarter of the U.S. physician workforce and provide equal and, in some instances, better care than U.S. graduates in high-need communities. [1]

The following five determinants form the foundation of this guide:

Executive Summary: Five Determinants of Residency Success

Factor Why It Matters
1. WFME-Recognized Accreditation Non-negotiable for ECFMG certification eligibility
2. Documented USMLE Pass Rates Schools with strong pass rates demonstrate curriculum quality
3. U.S. Clinical Rotation Access Essential for competitive letters of recommendation
4. Specialty-Aligned Placement History Indicates realistic pathways to target specialty
5. Visa Feasibility Determines geographic and specialty flexibility (non-U.S. citizens)

Key Factors When Choosing an International Medical School for U.S. Residency

Choosing an international medical school for US residency requires structured evaluation rather than reliance on rankings or marketing claims. The five determinants outlined above translate institutional variability into actionable criteria.

The sections that follow explain how to assess accreditation, USMLE preparation, clinical rotation access, specialty alignment, and visa feasibility in a systematic manner.

Guide Structure: Each determinant is explored in depth in the sections that follow.

Why Medical School Choice Influences U.S. Residency Outcomes

Program Director Familiarity

The medical school a student attends directly impacts how residency program directors evaluate their application. Program directors may be unfamiliar with previous institutions and referees of IMGs, as well as with the training structures in their countries of origin. [2]

In a 2022 NRMP survey, only 29% of program directors reported regularly considering U.S. citizen IMG applicants for an interview, and only 19% for non-U.S. citizen IMG applicants. [2]

Schools with established track records benefit from accumulated institutional recognition. When program directors have previously trained graduates from a particular school and observed their clinical performance, they develop confidence in that institution’s educational quality.

Institutional Track Records and Variability

There is considerable variability among international medical schools in the performance of their students against indicators of quality such as ECFMG and specialty board certification. [2]

By school, ECFMG certification rates have ranged from 28% to 86% for U.S. citizen IMGs and from 27% to 82% for non-U.S. citizen IMGs. [2]

Published studies demonstrate meaningful variability in certification rates across international schools, reinforcing the importance of institution-specific research rather than reliance on regional generalizations.

Geographic Match Clustering

IMG representation in the physician workforce varies significantly by region and practice setting. IMGs play a consistently greater role than U.S. medical school graduates in counties with medically underserved areas. [3]

Students should consider whether their target schools have alumni networks in regions where they hope to practice, as these connections can facilitate clinical rotations, letters of recommendation, and ultimately residency placement.

Key Takeaway: Medical school selection establishes the institutional context through which program directors evaluate an applicant’s qualifications and potential for success.

Determinant 1: ECFMG Eligibility and Accreditation

What ECFMG Certification Requires

Certification by the Educational Commission for Foreign Medical Graduates (ECFMG) serves as the standard initial evaluation process for IMG qualifications, preceding entry into U.S. residency programs. [4]

ECFMG certification necessitates:

  • Graduation from a medical school listed in the World Directory of Medical Schools
  • Formal assessment of English-language proficiency
  • Successful completion of USMLE Step 1 and Step 2 CK examinations
  • Clinical skills validation via several different pathways [4-5]

The 2023/2024 Accreditation Requirement

In 2010, ECFMG announced that beginning in 2023, graduation from a formally accredited medical school would be necessary for ECFMG certification eligibility. [6] Schools must be accredited by an agency recognized by the World Federation for Medical Education (WFME). By the end of 2022, WFME had recognized 33 accrediting bodies covering over three-quarters of the world’s medical schools. [7]

Accredited schools demonstrate higher rates of ECFMG certification among graduates than nonaccredited schools (75.0% vs. 68.3%). [2] After adjusting for age of school, longer duration of accreditation was associated with higher certification rates. [2]

How to Verify School Eligibility

  • Confirm the school’s listing in the World Directory of Medical Schools
  • Verify accreditation status through a WFME-recognized agency
  • Review historical ECFMG certification rates
  • Contact ECFMG directly if uncertainty exists
Key Takeaway: Accreditation verification is non-negotiable—enrollment at a non-accredited school eliminates the possibility of U.S. residency regardless of individual performance.

Determinant 2: USMLE Integration and Exam Preparation

Why Curriculum Alignment Matters

Schools with curricula aligned to U.S. medical education standards demonstrate stronger outcomes. First-attempt pass rates vary significantly by institution—ranging from 19.4% to 84.4% for Step 1 by country. [2] Average exam attempts for certified individuals ranged, by country of medical school, from 1.19 to 2.84 for Step 1 and from 1.20 to 2.13 for Step 2 CK. [8] This variability underscores the importance of researching school-specific outcomes.

The Step 1 Pass/Fail Transition

In 2022, USMLE Step 1 transitioned to pass/fail, increasing the importance of Step 2 CK performance. [2][9] IMGs are disproportionately affected by this shift—historically, Step 1 scores allowed IMGs to demonstrate mastery of fundamental concepts in direct comparison with U.S. applicants. [2] Step 2 CK scores are now the criteria most frequently reported as “very important” by internal medicine program directors (57%). [10]

Evaluating USMLE Support Systems

  • Whether Step 1 and Step 2 CK preparation is formally integrated into curriculum
  • Availability of dedicated USMLE faculty or tutoring resources
  • Historical first-time pass rates for graduates
  • Timing of dedicated study periods relative to examinations
Key Takeaway: Schools with robust board preparation infrastructure and high first-attempt pass rates provide measurable advantages in residency competitiveness.

Determinant 3: U.S. Clinical Rotations and Experience

The Critical Role of U.S.-Based Training

U.S. clinical experience provides significant advantages for IMG applicants. Seventy-three percent of program directors in one study found letters of recommendation from foreign countries to be “useless.” U.S. clinical experience provides: [11]

  • Letters of recommendation from U.S. physicians
  • Demonstrated ability to function in the U.S. healthcare system
  • Direct exposure to U.S. clinical practices and documentation standards
  • Networking opportunities with residency programs

Types of Clinical Rotation Access

Integrated U.S. Rotations: Some Caribbean schools conduct final years of training in affiliated U.S. hospitals. [2][12]

Elective Rotation Support: Other schools facilitate elective rotations at U.S. institutions without requiring them.

Independent Arrangements: Some programs have fewer formal U.S. partnerships, requiring students to arrange experiences independently.

Key Takeaway: Key Takeaway: When evaluating how to choose an international medical school for US residency, access to U.S. clinical experience is essential for obtaining competitive letters of recommendation and demonstrating familiarity with American medical practice.

Determinant 4: Specialty-Specific Considerations

Primary Care Pathways

IMGs have established strong representation in primary care. From 2010 to 2022, 22.1% of internal medicine positions were filled by foreign-born IMGs, along with 11.3% for pediatrics and 10.7% for family medicine. [13] Internal medicine remains the most common specialty choice for IMGs, accounting for 4,913 IMG first-year residents in 2024-2025. [13]

Primary care pathways offer several advantages for IMGs: higher match rates compared to competitive specialties, strong IMG representation creating welcoming program cultures, J-1 waiver opportunities in underserved areas, and growing demand due to physician workforce shortages.

Hospital-Based and Procedural Specialties

Some procedural specialties have lower IMG representation, requiring additional strategic planning: [4]

  • General surgery: 10.4% of allocated positions
  • Anesthesiology: 8.0%
  • Obstetrics and gynecology: 6.2%
  • Neurosurgery: 8.3%

Students targeting these specialties need exceptional applications with specialty-specific research, strong Step 2 CK scores, and meaningful U.S. clinical experience in the target field.

Research-Intensive and Competitive Specialties

Highly competitive, research-intensive specialties present the greatest challenges for IMG applicants: [4]

  • Dermatology: 3.3% of allocated positions
  • Plastic surgery: 2.8%
  • Otolaryngology: 2.1%
  • Orthopedic surgery: 0.9%

Students with aspirations toward these fields should carefully evaluate whether international medical education aligns with their goals. Success in these specialties typically requires exceptional research productivity, strong institutional connections, and often preliminary training in less competitive fields.

School Selection and Career Goals

Academic Medicine: IMGs who choose academic careers are less likely to obtain leadership positions. [1] Students targeting academic medicine should prioritize schools with university program placement records and research infrastructure.

Community Practice: Community programs recruit IMGs at significantly higher rates than university programs (55-70% of positions vs. 22-30%), creating strong pathways for community-oriented practice. [14]

Underserved Areas: IMGs are more likely than U.S. medical graduates to work in shortage areas. [15] The Conrad 30 waiver program creates meaningful pathways for IMGs committed to serving underserved communities.

Key Takeaway: Specialty selection should inform school selection—students targeting competitive specialties need schools with exceptional preparation infrastructure, research opportunities, and U.S. clinical rotation access.

Determinant 5: Visa Implications for International Medical Training

Understanding Visa Categories

Non-U.S. citizen IMGs must navigate the U.S. visa system for residency training. Eligibility criteria, requirements, and processing times vary significantly and can exceed the timeline program directors can accommodate to ensure an on-time start. [4]

J-1 (Exchange Visitor) Visa: Most common for residency training. Requires return to home country for two years unless a waiver is obtained. [4][16]

H-1B (Specialty Occupation) Visa: Allows longer-term U.S. employment but has annual caps and requires employer sponsorship. Generally considered better regarding U.S. permanent residence and ease of maneuverability through graduate medical education. [17]

Green Card: Provides the most flexibility but requires sponsorship and longer processing times. Despite being arduous and difficult to obtain, the Permanent Resident Card is the most robust choice available to non-U.S. citizen IMGs who have a U.S. citizen family member to sponsor them. [4]

Sponsorship Patterns by Specialty and Program Type

After cuts to graduate medical education funding, many programs stopped sponsoring H-1B visas and switched to the cheaper J-1 option. [15] Students should research which programs in their target specialty sponsor their preferred visa type, as policies are often established at the institutional level without input from individual programs. [17]

The Conrad 30 Waiver Program

Each state has 30 annual waivers to the J-1 two-year requirement, provided IMGs commit to practicing in high-need areas. [4][15] Between 2001 and 2020, this program recruited 18,504 physicians, marking a 111% increase in annual recruitment. [15] States with fewer applicants may have more available waivers, and some states have additional waiver programs beyond Conrad 30.

Strategic Considerations for U.S. Citizens

U.S. citizens attending international medical schools maintain significant advantages: no visa requirements for clinical rotations, eligibility for all residency positions without sponsorship concerns, higher match rates (67.0% vs. 58.5% in 2024), and no geographic restrictions based on waiver requirements. [4]

Key Takeaway: Non-U.S. citizens should research visa sponsorship patterns early, as these considerations affect specialty choice, geographic flexibility, and long-term career planning.

Residency Match Statistics: 2020–2025 Analysis

IMG Match Trends

Year Total PGY1 Positions Non-U.S. IMGs Matched Percentage Year-over-Year Change References
2020 32,399 4,222 13.03% — [1]
2021 33,353 4,356 13.06% +3.17% [1]
2022 34,075 4,571 13.41% +4.94% [1]
2023 34,822 5,032 14.45% +10.08% [1]
2024 35,984 5,864 16.30% +16.53% [1]
2025 37,667 6,653 17.66% +13.45% [1]

[1][18]

Interpreting These Trends

These figures demonstrate consistent and accelerating growth in IMG representation. Non-U.S. IMG matches increased by over 57% from 2020 to 2025, outpacing the 16% growth in total PGY1 positions during the same period. This trend reflects both expanding residency capacity and growing recognition of IMG contributions to the physician workforce.

The acceleration in IMG matches from 2023 onward is particularly notable, with year-over-year increases exceeding 10% for three consecutive years. While overall match rates remain lower than U.S. MD seniors, the consistent improvement in U.S. citizen IMG match rates between 2021 and 2025 reflects expanding residency capacity and increasing institutional familiarity with international graduates.

In 2024, U.S. citizen IMGs achieved a 67.0% match rate and non-U.S. citizen IMGs achieved 58.5%. [4] The gap between U.S. citizen and non-U.S. citizen IMG match rates (approximately 8.5 percentage points) highlights the additional advantages of U.S. citizenship, including visa flexibility and program director familiarity. Non-U.S. citizen IMG residency applicants reported an average of 6.3 prior work experiences compared with 3.6 among U.S. MD seniors, and peer-reviewed publications represented a greater percentage of outputs for IMGs. [2]

Key Takeaway: IMG match rates are growing, and success is achievable for candidates who build comprehensive applications with strong USMLE scores, U.S. clinical experience, and research productivity.

Regional Comparison: Where to Study Medicine Abroad

Caribbean Medical Schools

Caribbean institutions remain the most frequently chosen international destination for U.S. and Canadian students. [12] These programs are designed to prepare graduates for U.S. residency training.

Strengths: Curricula modeled on U.S. standards; many schools offer clinical rotations at affiliated U.S. hospitals; English-language instruction; familiarity among program directors; established USMLE preparation infrastructure. [2][12]

Key Considerations: Performance varies significantly across institutions. ECFMG certification rates range from 19.1% to 91.5% by country within the Caribbean. [8] Students must research school-specific outcomes.

Notable Institutions: St. George’s University (Grenada), American University of the Caribbean (St. Maarten), Ross University School of Medicine (Barbados), Saba University School of Medicine.

Summary: Caribbean schools offer the most direct pathway to U.S. residency for students who select high-performing institutions. The difference between top-tier and lower-tier institutions can mean the difference between a 90%+ ECFMG certification rate and rates below 30%.

Eastern European Medical Schools

Eastern European schools have become increasingly attractive, with many offering English-language programs. WFME has recognized accrediting bodies covering European institutions. [7]

Strengths: Often more affordable tuition; strong foundational science education; exposure to diverse patient populations; growing recognition among U.S. programs; English-language programs available.

Key Considerations: Program length is typically 5-6 years; students should proactively arrange U.S. clinical experiences; verify WFME-recognized accreditation before enrollment.

Notable Institutions: First Faculty of Medicine, Charles University (Czech Republic); Semmelweis University (Hungary); Jagiellonian University (Poland); University of Debrecen (Hungary).

Summary: Eastern European schools offer cost advantages and strong foundational training but require students to be more proactive about USMLE preparation and U.S. clinical experience.

United Kingdom and Ireland

UK and Irish schools offer high-quality educationn global recognition, English language instruction and are often considered by applicants analyzing how to choose an international medical school for US residency.

Strengths: Prestigious academic institutions; robust clinical training; English-language instruction; degrees recognized worldwide.

Key Considerations: Program length is typically 5-6 years; substantial tuition for international students; students should supplement with USMLE-specific preparation; U.S. clinical rotations require independent arrangement.

Notable Institutions: King’s College London; University of Edinburgh; Royal College of Surgeons in Ireland; University College Dublin.

Summary: UK and Irish schools provide excellent medical education with global prestige, but students must independently navigate USMLE preparation and U.S. clinical experience.

Regional Comparison Summary

Factor Caribbean Eastern Europe UK/Ireland References
Program Length 4 years 5–6 years 5–6 years [1–2]
U.S. Clinical Rotations Extensive (top schools) Limited partnerships Limited partnerships [2–3]
USMLE Integration Strong Variable Limited [3–4]
Relative Tuition Moderate–High Lower High [1]
Program Director Familiarity High Growing Moderate [3,5]

[2][4][11–12]

Common Mistakes When Choosing an International Medical School

1. Prioritizing Tuition Cost Over Outcome Data

Lower tuition does not compensate for poor USMLE pass rates or low ECFMG certification rates. Calculate the true cost including risk of delayed graduation and multiple exam attempts.

2. Ignoring Accreditation Status

Enrollment at a school without WFME-recognized accreditation eliminates the possibility of ECFMG certification regardless of individual performance. [6]

3. Relying on Regional Generalizations

ECFMG certification rates range from 19.1% to 91.5% by country within the Caribbean alone. [8] Research school-specific outcomes rather than assuming regional uniformity.

4. Underestimating U.S. Clinical Experience Importance

Seventy-three percent of program directors found letters from foreign countries “useless.” Schools without U.S. clinical rotation access require students to independently arrange these experiences. [11]

5. Failing to Consider Specialty Alignment

Students targeting competitive specialties face significantly lower match rates. Selecting a school without considering specialty-specific outcomes leads to misaligned expectations.

6. Overlooking Visa Implications

Non-U.S. citizens who do not research visa sponsorship patterns may find specialty and geographic options severely limited after graduation.

7. Not Seeking Expert Guidance

Building a competitive residency application requires strategic coordination of clinical rotations, research opportunities, USMLE preparation, and application strategy. The challenge for many IMG students and graduates is accessing academic advising aligned with match requirements.

Specialized IMG-focused academic advising services work collaboratively with students and graduates to build comprehensive applications—coordinating these elements into a cohesive plan.

A Structured Evaluation Framework for Prospective Students

Accreditation

  • School is listed in the World Directory of Medical Schools
  • Accrediting agency is recognized by WFME [6–7]
  • Accreditation has been in place for multiple years [2]
  • No pending accreditation concerns or probationary status

USMLE Preparation

  • School provides documented first-attempt USMLE pass rates
  • Step 1 and Step 2 CK preparation is integrated into curriculum
  • Dedicated study periods are provided before examinations
  • USMLE faculty or tutoring resources are available

Clinical Training Infrastructure

  • U.S. clinical rotations are available (integrated or facilitated)
  • Rotations occur at teaching hospitals with residency programs
  • Students can obtain letters from U.S. physicians
  • Clinical sites align with target specialty interests

Specialty Alignment

  • School has graduates who have matched into target specialty
  • Research opportunities exist in field of interest
  • Clinical rotations are available in target specialty
  • Alumni network includes physicians in target specialty

Visa Considerations (Non-U.S. Citizens)

  • Target specialty programs commonly sponsor preferred visa type
  • J-1 waiver opportunities align with geographic preferences
  • Long-term immigration pathway is understood

Historical Match Outcomes

  • School provides transparent match rate data
  • ECFMG certification rates are documented and strong [2][8]
  • Graduation rates and time-to-degree are reasonable
  • Attrition rates are disclosed and acceptable

Building a Competitive Residency Application

Key Application Components

USMLE Performance: With Step 1 now pass/fail, Step 2 CK scores carry increased weight—reported as “very important” by 57% of internal medicine program directors. [10]

Research Productivity: IMGs demonstrate strong research engagement. Research outputs per experience were highest among non-U.S. citizen IMGs (2.5 vs. 2.0 for U.S. MD seniors). [2]

Letters of Recommendation: U.S.-based letters from physicians who have directly supervised clinical work carry significant weight.

Clinical Experience: Document all clinical experiences thoroughly, emphasizing hands-on patient care responsibilities.

Application Strategy

  • Apply to programs with established track records of training IMGs
  • Research program-specific preferences before applying
  • Demonstrate geographic flexibility when appropriate
  • Tailor personal statements to highlight unique strengths
  • Prepare thoroughly for interviews

Frequently Asked Questions

How do Caribbean medical schools compare to Eastern European programs for U.S. residency preparation?

Caribbean schools generally offer stronger USMLE integration and more extensive U.S. clinical rotation networks, with top institutions conducting final clinical years at affiliated U.S. hospitals. [2][12] Eastern European programs typically offer lower tuition and strong foundational science education but require students to independently arrange USMLE preparation and U.S. clinical experiences. Caribbean schools also benefit from greater program director familiarity. [2] However, performance varies dramatically within both regions—school-specific outcomes matter more than regional generalizations.

How competitive are IMGs for U.S. residency positions?

In 2024, U.S. citizen IMGs achieved a 67.0% match rate and non-U.S. citizen IMGs achieved 58.5%, compared to 93.5% for U.S. MD seniors. [4] While these rates are lower, they represent meaningful opportunities—IMGs secured 23.5% of all residency positions in 2024. [4]

How does visa status affect residency options?

Non-U.S. citizen IMGs face additional considerations including visa sponsorship requirements and potential geographic restrictions. The J-1 visa is most common for residency training but requires a two-year home country return unless a waiver is obtained. [4][16]

What are the ECFMG eligibility requirements?

ECFMG certification requires graduation from a medical school listed in the World Directory of Medical Schools and accredited by a WFME-recognized agency, successful completion of USMLE Step 1 and Step 2 CK, English proficiency verification, and clinical skills validation. [4-6]

Conclusion: The Three Decisive Criteria

Selecting an international medical school for U.S. residency requires systematic evaluation rather than reliance on marketing claims or intuition. Evidence consistently identifies three institutional characteristics that most strongly predict residency success.

1. Accreditation and Institutional Quality

Schools with WFME-recognized accreditation and strong ECFMG certification outcomes provide the structural foundation for residency eligibility. Accredited schools demonstrate higher certification rates than nonaccredited institutions (75.0% vs. 68.3%), and longer accreditation duration correlates with improved outcomes. [2]

2. USMLE Performance Infrastructure

Schools with documented first-attempt pass rates and integrated board preparation demonstrate curriculum quality that translates to competitive residency applications. With Step 2 CK carrying increased weight, institutions that adapt preparation strategies position graduates for stronger outcomes. [2][10]

3. U.S. Clinical Rotation Access

Schools with established U.S. hospital affiliations provide the clinical experience and letters of recommendation residency programs require. The finding that 73% of program directors consider foreign letters “useless” underscores the importance of U.S.-based clinical experience. [11]

Medical school choice produces compounding effects. The institution selected determines accreditation eligibility, shapes USMLE preparation, establishes clinical rotation access, and influences how residency programs interpret an applicant’s qualifications.

Applicants who verify accreditation, research school-specific outcomes, and prioritize clinical training infrastructure position themselves for successful residency matches and long-term medical careers in the United States.

The pathway from international medical school to U.S. residency is well established and increasingly common. Between 2020 and 2025, IMG matches increased by more than 57%, and international graduates now comprise nearly one-quarter of the U.S. physician workforce. Strategic school selection combined with structured application preparation continues to produce successful outcomes. [1][18]

Plan Your Residency Strategy

IMGPrep has guided hundreds of international medical graduates through the U.S. residency process, working across specialties and institutional contexts to build competitive residency applications.

Successful applicants combine careful medical school selection with structured preparation in USMLE performance, U.S. clinical experience, research productivity, and residency application strategy.

If you are evaluating international medical schools, these additional guides may help:

Speak With an IMGPrep Advisor

References

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  2. International Medical Graduates and the Physician Workforce. McElvaney OJ, McMahon GT. JAMA. 2024;332(6):490-496.
  3. Evolution of Educational Commission for Foreign Medical Graduates Certification in the Absence of the USMLE Step 2 Clinical Skills Examination. Mladenovic J, van Zanten M, Pinsky WW. Academic Medicine. 2023;98(4):444-447.
  4. Examining the Educational Commission for Foreign Medical Graduates Announcement Requiring Medical School Accreditation Beginning in 2023. Tackett S. Academic Medicine. 2019;94(7):943-949.
  5. Examining the WFME Recognition Programme at 10 Years. Tackett S, Whitehead CR, Rashid MA. Medical Teacher. 2024;46(5):711-718.
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  7. Medical Education in the Caribbean: Variability in Medical School Programs and Performance of Students. van Zanten M, Boulet JR. Academic Medicine. 2008;83(10 Suppl):S33-S36.
  8. Challenges to the Future of a Robust Physician Workforce in the United States. Walensky RP, McCann NC. New England Journal of Medicine. 2025;392(3):286-295.
  9. Offshore Medical Schools Are Buying Clinical Clerkships in U.S. Hospitals. Halperin EC, Goldberg RB. Academic Medicine. 2016;91(5):639-644.
  10. Private Schools of the Caribbean: Outsourcing Medical Education. Eckhert NL. Academic Medicine. 2010;85(4):622-630.
  11. How Immigration Policy Threatens US Medical Training and Patient Care. Jacobs JW et al. JAMA. 2025;334(6):483-484.
  12. Regional Distribution of Foreign-Born Medical Graduates in US Primary Care Specialty Residencies From 2010 to 2022. Nakhostin-Ansari A, Tackett S. Journal of General Internal Medicine. 2025;40(2):347-353.
  13. US Graduate Medical Education, 2002-2003. Brotherton SE, Rockey PH, Etzel SI. JAMA. 2003;290(9):1197-1202.
  14. Graduate Medical Education, 2024-2025. Andrews JS, Mathews C, Kolli SK. JAMA. 2025;334(17):1572-1598.
  15. Where Do International Medical Graduates Matriculate for Internal Medicine Training? Reddy ST et al. Journal of General Internal Medicine. 2021;36(8):2230-2236.
  16. Medical Education in the Caribbean: Variability in Educational Commission for Foreign Medical Graduate Certification Rates. van Zanten M, Boulet JR. Academic Medicine. 2009;84(10 Suppl):S13-S16.
  17. The Implications of the Current Visa System for Foreign Medical Graduates During and After Graduate Medical Education Training. Al Ashry HS et al. Journal of General Internal Medicine. 2019;34(7):1337-1341.
  18. Educational Commission for Foreign Medical Graduates Certification and Specialty Board Certification Among Graduates of Caribbean Medical Schools. Norcini JJ et al. Academic Medicine. 2006;81(10 Suppl):S112-S115.