Caribbean Med School Mythbusters: IMGs, U.S. Residencies
In a 2016 survey conducted by the National Residency Matching Program (NRMP), the directors of every residency that participates in the Main Residency Match were asked what they considered when they evaluated applications and when they ranked candidates they had interviewed. They were also asked how important each factor was to them. The results contradict the notion that international medical graduates (IMGs) have great difficulty matching to US residencies, and affirm AUA’s values as an institution.
Of the 39 factors directors listed as things they consider in the application process, the five most commonly cited when deciding who to interview were: “USMLE Step 1/COMLEX Level 1 score” (93 percent); “Letters of recommendation in the specialty” (88 percent); “Medical Student Performance Evaluation (MSPE/Dean’s Letter)” (84 percent); USMLE Step 2 CK/COMLEX Level 2 CE score (83 percent); and “Grades in required clerkships” (79 percent).
Only 56 percent of program directors listed “Graduate of highly-regarded U.S. medical school” as a factor for inviting residency candidates to interview.
They were asked to rate each of the factors they had listed on a scale of 1-5, 1 indicating the factor being “not at all important,” and 5 being “very important.” This measure reflected the same trend. The average rating for “Graduate of highly-regarded U.S. medical school” was just 3.8.
Other than potentially disqualifying factors, e.g. “Applicant was flagged with Match violation by the NRMP,” they considered the most important criteria to be:
“Evidence of professionalism and ethics” (4.5); “Perceived commitment to specialty” (4.3); “Grades in clerkship in desired specialty” (4.3); Passing the USMLE Step 1 & 2 (4.2); and Personal Prior Knowledge of the Applicant (4.2). “Perceived Interest in the Program,” (4.1); “Leadership Qualities” (4.1); “Audition elective/rotation within your department” (4.1); “Consistency of grades” (4.1); and “Medical Student Performance Evaluation (MSPE/Dean’s Letter)” (4.1) also figured prominently.
When the residency directors were asked the same questions about how they ranked students they had actually interviewed, the results were similar. The three most commonly cited criteria for ranking applicants were “Interactions with faculty during interview and visit” (95 percent); “Interpersonal skills” (95 percent); and “Interactions with house staff during interview and visit” (90 percent). On average, they ranked all of these criteria 4.8 in terms of importance. “Feedback from current residents,” was close behind—cited 86 percent of the time, and ranked 4.7 in importance. “Evidence of professionalism and ethics” was mentioned 67 percent of the time, and ranked 4.6 in importance.
Only 41 percent of program directors seemed concerned enough that an interviewee was a “graduate of a highly-regarded U.S. medical school,” and on average, they ranked it just 3.9 percent in importance during the ranking process.
These data drive home the reality, which is that the gatekeepers of U.S. residency programs value the same things that we do as noted in our Mission Statement. We are more concerned with sending highly skilled, compassionate doctors, with leadership skills they can take into the communities that need them most than we are with padding resumes.
Our own numbers show that our approach is working:
- Ninety-six percent of AUA students have passed the critically important USMLE Step 1 on their first attempt, over the past three years.
- Our graduates have obtained residencies in more than 700 programs throughout the United States, as well as in Canada.
AUA graduates have matched to residency programs and obtained fellowships at prestigious institutions such as:
Cleveland Clinic Foundation
University of Chicago
University of Toronto
This may be surprising if you haven’t yet questioned the conventional wisdom about IMG residency placement rates in U.S. programs. However, once you do, it makes perfect sense. Residency directors value the same characteristics in applicants that we do when we decide whether to admit students to our MD program. We have a US-modeled Basic Sciences curriculum that emphasizes clinical applications from day one. This prepares them for their rotations and to be competitive residency candidates. Our graduates often attribute their success in the Match to these factors, as well as having had the opportunity to learn from and network with residents and attendings at our 35+ hospital affiliates across the U.S., in Canada and in India.
When you step back and look at all the evidence, it’s easy to separate fact from fiction. We are extremely proud of our alumni and all their successes, but no, we’re not surprised at all.