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What You Really Need to Know About Being an International Medical Graduate

I am a proud graduate of St. George’s University, a medical school located on the beautiful Caribbean island of Grenada. My experience living in this tropical island paradise for two years was completely life-changing and it will always be a time in my life that I look back on fondly over the years.

However, prior to my acceptance to an international medical school, I was quite apprehensive about attending after reading all of the “horror stories” posted in online medical student forums. There are quite a few nasty things said about students who choose to go abroad for medical school, and it seems that this stigma alone is enough to keep many students from even considering an application.

As someone who has actually been through an international med school program (as opposed to many of the online naysayers who are simply repeating rumors), I am here to answer some commonly asked questions and dispel a few myths about IMGs so that we can all be as informed as possible!

What is an “IMG”?

An IMG is an “international medical graduate,” which means that they are a physician who graduated from a medical school located outside of the United States. The term is also colloquially used to describe medical students who currently attend international schools, regardless of their US citizenship status, as there is really no term to describe “international medical students” as a separate entity.

What’s the difference between IMG and FMG?

While IMG stands for “international medical graduate,” FMG stands for “foreign medical graduate,” so these terms are essentially interchangeable as both refer to a physician who graduated from a medical school located outside of the United States. However, the term “FMG” is traditionally used to refer to IMGs who are not US citizens.

Are IMGs able to practice medicine in the United States?

Yes! IMGs can practice medicine in the US and undergo a rigorous certification process by the Educational Commission for Foreign Medical Graduates (ECFMG), a non-profit organization that has certified more than 320,000 international medical graduates to practice in the United States since 1956.

ECFMG assesses whether IMGs are prepared to enter United States graduate medical education (GME) programs (aka residencies) that are accredited by ACGME. ECFMG certification is also required for IMGs to take USMLE Step 3 and for final unrestricted licensing to practice medicine in the US. This is determined through medical science examinations, evaluation of English proficiency, and documentation of medical school credentials.

What extra requirements do IMGs need to meet in order to match in the United States?

Traditionally, IMGs are required to pass USMLE Step 1, Step 2 CK, and Step 2 CS in order to become ECFMG certified and participate in the NRMP Match.

However, since Step 2 CS was indefinitely suspended in May 2020 due to COVID-19, a series of alternative pathways was developed to allow these international medical students and graduates to qualify for the 2021 Match.

Applicants must prove English proficiency by taking the Occupational English Test (OET), an approximately four-hour exam consisting of reading, writing, listening, and speaking components. This exam is required even if an IMG is a United States citizen, attended a medical school taught in English, and has passed previous medical licensing exams such as Step 1 and Step 2 CK in English, which has caused some controversy in the medical education community.

Additionally, the examination costs ~$450 USD, and IMGs also have to pay a $900 fee just to submit their application for ECFMG certification, which is non-refundable even if the student does not become certified.

In addition to the OET, each medical student must have a Clinical Attestation Form submitted by their medical school which states that the student has successfully completed a series of graded clinical encounters and that the school will vouch for their clinical competency.

MYTH: People who attend international medical schools couldn’t get into schools in the US.

Prospective medical students may view Caribbean or other international programs as “second chance schools” that you should only apply to if all other options have been exhausted.

For some students, this is certainly the case. More than 50,000 students apply for US medical schools each year, but only about 42% of those applicants actually matriculate. This leaves out a large pool of qualified applicants who may have been “weeded out” of the application process due to below average MCAT scores or GPA, weak letters of recommendation or personal statements, etc.

There simply aren’t enough spots available to accommodate every single qualified applicant. International schools can be a great option for students who have taken a few “gap years” off between undergrad and medical school to pursue other career interests, start a family, or work on improving their application.

However, some students actually choose to attend an international school because they would like to experience life in a foreign country, learn a new language, or immerse themselves in an unfamiliar culture during medical school. There are many reasons why students may choose to attend an international school, and it’s important to consider what is best for you.

MYTH: The quality of education at international medical schools is worse than US schools.

By nature of the stringent accreditation process that international medical schools must follow so that their students can match into US residency positions, it is essential that these schools are held to the same educational standards as schools in the United States.

One way to judge the quality of an international school’s education quality is by the percentage of its students who pass USMLE Step 1 for the first time. For example, St. George’s University in Grenada has a >94% first-time pass rate on USMLE Step 1, which is comparable to that of US schools.

SGU also matched over 1,100 students into US and Canadian residency positions in 2020, and boasts a total of 18,000 alumni who have entered the global healthcare system.

MYTH: International medical graduates cannot match into competitive specialties.

While it is certainly more common for IMGs to match into primary care specialties such as family medicine, internal medicine or pediatrics, it is certainly possible to match into a competitive specialty as an IMG with an outstanding CV and exam scores! According to the 2020 NRMP IMG Match data, IMGs filled 5% of positions in plastic surgery, 5% in vascular surgery, 6% in physical medicine and rehabilitation, and almost 8% in neurosurgery.



It is important to recognize that attending an international medical school is a personal choice that requires a lot of thought, and it may not be right for every medical student. Do your research and always consider the source of whatever information you happen to come across on the internet. Try to set aside any judgements or preconceived notions you may have about IMGs when considering which option is best for you. International medical students, regardless of US citizenship status, can make incredible doctors, and it is very likely that you will work alongside one or even be treated by one some day!