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.

NRMP Matches 52.4% of Foreign Medical Students to U.S. Residencies in 2017

The National Resident Matching Program, or NRMP, announced the largest number of medical residency applicants and placements in 2017. The program places medical school students and graduates in residencies using a Nobel-prize winning algorithm. To be included in the program, medical school students submit applications and interview with programs starting in the fall and continuing through early winter. The program directors and applicants then rank their order of preference. The algorithm matches applicants to residency programs. This successful program continued in 2017 with over 35,000 medical school student and graduate applicants.

In 2017, these medical school students and graduates competed for over 31,000 positions. 94% of U.S. allopathic seniors were successfully matched. This is a consistent number from year to year. However, the placement rate for non-U.S. citizen international medical school graduates and students (also known as FMGs) is much lower, only 52.4%.  Over 7,000 FMGs applied in 2017 and less than 4,000 were placed. NRMP notes that this is the highest match rate since 2005, so 52.4% is better than average.

The lower match rate of international medical students suggests that these students may need additional support to successfully match with U.S. residency programs. Comparing the experiences of U.S. seniors and foreign medical students might illuminate some difference that account for the lower match rate. U.S. allopathic seniors follow a standard process for medical residency matching. They know when to take their USMLE (United States Medical Licensing Examination). In many cases, their medical school can support and guide them through the process. For foreign medical students, their medical school might not be able to provide the support and guidance needed to obtain a residency in the United States. The medical school’s process might be set up for medical residency in the local area.

U.S. students might also have an advantage during interviews. Resumes are written and interviews are conducted in their native language. Additionally, many U.S. school provide workshops on resume writing and interviewing. Foreign medical students may not have access to this support.

Hand-on clinical experience might also help U.S. students rise through the ranks. Many medical schools including clinical experience as part of the curriculum. These schools partner with U.S. hospitals and clinics for training. Foreign medical students may have clinical training in their native country. However, interviewing residencies may be more comfortable accepting students with training at known U.S. institutions.

It seems as though foreign medical students are at a disadvantage when it comes to medical residency placement. However, additional support can enable international medical students and graduates to be successfully matched to a U.S. residency. Hands-on clinical experience in the U.S., resume advice, and interview preparation are likely to increase the chances that a FMG will be matched with his or her preferred medical residency.