Three Benefits of U.S. Clinical Externships for Foreign Medical Graduates

Clinical externships allow foreign medical students to test their skills at U.S. medical institutions. In a clinical externship, a foreign medical graduate (FMG) is placed with an attending at a U.S. institution. Depending on the length of the externship, FMGs may have the chance to learn from multiple attendings in different specialties. Not only is this an excellent learning opportunity, FMGs that complete clinical externships are more likely to match with a U.S. medical residency. They have more of the tools necessary to successfully interview and match.

Meet Requirements for U.S. Medical Residencies

Many U.S. residency programs require time spent working in the U.S. This is an easy requirement for U.S. allopathic seniors, who can complete clinical studies at their medical schools or neighboring institutions. Foreign medical graduates, however, must relocate to the U.S. for an extended period of time to meet these requirements. Unfortunately, every U.S. medical residency has a different requirement for the amount of U.S. clinical experience. While a 3 month externship may be enough for one program, it’s not enough for another. FMGs should review the requirements of their preferred medical residency program to determine the length of externship that is required.

Receive Letters of Recommendation

Letters of recommendation from U.S. doctors are a great tool for foreign medical graduates during the interviewing process. The interviewing program is likely to trust known U.S. doctors more than unknown foreign doctors recommending a graduate for a program. For some schools, it is a requirement that faculty member write a letter of recommendation for a foreign medical graduate. It would not be possible for a FMG to match with this type of school unless they completed a externship with a faculty member or knew a faculty member through other means.

Learn U.S. Terminology and Common Ailments

Externships also prepare FMGs for the U.S. testing required to match with a medical residency. There is a clinical section to the exam. A foreign medical graduate who has already spent time working in a U.S. institution will not be surprised by any differences in protocol. They already learned the basics at an externship. The skills gained at the externship can immediate translate to the exam. FMGs who complete externships will also become more familiar with common U.S. ailments, which are more likely to appear on the clinical exam.

Clinical externships are not only beneficial for FMGs, but, in many cases, they are a requirement for matching with a U.S. medical residency. Selecting the right externship can make the difference between matching with a U.S. medical residency or not being able to do so.

U.S. Residences have Additional Requirements for FMGs

Unlike U.S. allopathic medical school seniors, foreign medical graduates (FMGs) must meet additional requirements to be considered for U.S. medical residencies.  These additional requirements may be one reason that FMGs are not placed in the NRMP Match Program at as high of rate as U.S. allopathic seniors. To be fully prepared for the NRMP process, foreign medical graduates can educate themselves on typical U.S. medical residency requirements. The University of Washington’s internal medicine application site provides an example of the additional requirements that FMGs face when trying to match with a U.S. residency.

If applying to the University of Washington medical program, FMGs have to meet these requirements (in addition to the typical personal statement, transcripts and letters of recommendation).

Must be a permanent resident of selected states OR sponsored by faculty

Because most foreign medical graduates are not permanent residents of Washington, Montana, Wyoming, Alaska or Idaho, most applicants will have to meet the second requirement, faculty sponsorship. The faculty member must write a letter explaining how he or she knows the foreign medical graduate and what qualifications the FMG possesses. Foreign medical school graduates may be able to find a link to a University of Washington faculty member through their medical school. Another option for FMGs is to try to obtain a clinical clerkship or internship with a University of Washington faculty member. This can be a difficult requirement to meet and it is only the first of three.

Must have 2 weeks of clinical clerkship at an LCME-accredited medical school OR four months of residency at an ACGME-accredited program

The University of Washington also specifies that these clerkships and residencies must be at a Puerto Rican, Canadian or U.S. location. Foreign medical graduates that have only worked in their native countries will not meet this requirement. To be able to apply for residency at the University of Washington, FMGs will need to obtain one of these clerkships or residencies. For the LCME clerkship option, there are 155 qualifying schools. For the ACGME residency option, FMGs can select from schools listed on the ACGME list.

Must apply through the ECFMG ERAS Program

The online ERAS application program certifies that FMGs meet the same clinical standards as U.S. allopathic seniors. There are three exams that FMGs must pass in order to apply through this program. It is likely that foreign medical graduates will have to visit the U.S. for at least one of these exams. Therefore, it is imperative to have enough time to meet these requirements before the application and interviewing process for NRMP begins.

Many U.S. medical residencies, including the University of Washington, have additional requirements for foreign medical graduates. FMGs should examine what requirements are needed long before the fall application and interview process. Some requirements, like a 4 month residency or 2 week clerkship, require travel and take weeks or months to complete. By researching these additional requirements early, FMGs can be prepared for the NRMP matching process.