U.S. Medical Education and Training System
The American medical education process is complex for physicians who received training in other countries. Residency training is generally recognized as a challenging period in which new physicians grapple with longer work hours, higher expectations and a greater level of responsibility.
In order for a graduate of an international medical school to work as a licensed physician in the United States, he or she must obtain graduate-level medical education—residency—in the U.S. and obtain appropriate licensure. Therefore, IMGs have to redo their residency in U.S.
International medical students must also take the United States Medical Licensing Exam (USMLE).
USMLE consist of three different steps:
- An assessment of a candidate's understanding of and ability to apply basic science principles.
- Step 2-Clinical Knowledge (CK) focuses on the application of medical knowledge for patient care.
- Step 2-Clinical Skills (CS) uses standardized patients to evaluate the ability of the candidate to take histories, perform physical examinations and communicate with patients.
- A final examination in the USMLE series that is required to get a license as a practicing physician. Not all programs require that a candidate take this step before applying for a Graduate Medical Education (GME) position.
IMG physicians, just like U.S. medical school graduates (USMG physicians), learn in March ("Match Day") whether and where they were "matched" into a residency program. IMG physicians who are not U.S. citizens or permanent residents (also sometimes referred to as F-IMGs) at this point need to obtain an appropriate immigration visa for training and work in the U.S. (See section on Immigration).
Beginning Your Residency
When new resident physicians start their residency and begin to see patients, they want to demonstrate their medical knowledge and desire to learn from their residency program director. IMG physicians who have recently arrived in the U.S. may find that they are struggling to accomplish this goal while becoming comfortable in new work, learning, language and idioms, and living environments.
Since resident physicians in the U.S. are still considered students, each new resident must become acquainted with his or her residency program's evaluation system. Residencies generally have required assessments by one's teachers or attending physicians. They also have to meet expected competency requirements for each year of training based on ACGME's set milestones.
In addition to faculty evaluations of the resident's performance, most medical disciplines require the resident to complete yearly written training exams. For example, psychiatry trainees must complete the Psychiatry Resident-In-Training Examination (PRITE).
While still in residency, IMG physicians, like their USMG physician colleagues, begin to consider the steps necessary to obtain a permanent license to practice medicine and board certification in their chosen specialty. Medical licensure requirements may vary from one state to another. State licensure requirements are outlined to provide that IMGs meet the same requirements to obtain a license as AMGs or graduates from Canadian medical schools.
Some residency programs require that physicians obtain permanent licenses in their third year to stay in the residency program. Others will allow a resident to continue in training with a temporary license until they graduate.
Just like all USMG physicians, IMG physicians will want to consider joining and participating in the programs offered by organized medical professional societies. On a national level, membership in the American Psychiatric Association is available to all physicians during and after training.