International medical students face several challenges when they seek rotations in the United States. EMRA, along with our Medical Student Council, worked with relevant stakeholders — including EM program directors, clerkship directors, and international medical graduates (IMGs) — to identify major barriers.
The 4 main barriers are: finances; lack of access to the Association of American Medical Colleges’ Visiting Student Learning Opportunities (VSLO) program; need for visa sponsorships; and programs that reject international student participation in rotations.
We elaborate on each barrier below.
The financial impact of applying for, and attending, audition rotations is certainly an issue for all medical students — allopathic, osteopathic, and international. However, international students have a higher financial investment during the rotation and interview seasons.
Virtual interviews have helped, but there is still the need to travel to the U.S. for rotations and move stateside after graduation.1,2 Some institutions charge international medical students more than allopathic or osteopathic students to rotate, making the disparity even greater.
In speaking with stakeholders, this fee is due to the institution not having a contract with most IMG schools, as well as a lot of osteopathic schools. This results in a required fee that goes toward the costs of creating contracts and obtaining required insurance. A simple Google search highlighted several programs that required an additional fee for international students. Johns Hopkins, for example, wrote “an additional registration fee of $5000 per clinical elective is charged for visiting students from schools not accredited by LCME or COCA.”
Thankfully, many programs have started to create diversity externships/scholarships to offset costs associated with rotations for diverse students. See EMRA’s Diversity Oriented Away/Scholarship Programs webpage for a list of institutions that have such scholarship opportunities. Also check out EMRA Match for Clerkships and select the Diversity Externship Scholarship filter under Rotation Types in the upper banner of the webpage.
While we recognize that not all international students come from diverse backgrounds, for those who do, these scholarships can help offset the costs of rotations.
Lack of Access to VSLO
International medical students face an uphill battle to obtain away rotations due to limited access to VSLO, as this AAMC program only allows certain types of medical schools to create accounts for students. Students do not always know of programs that do not use VSLO for away applications. When discussing this issue with stakeholders, they recommended international students who cannot use VSLO search for rotations on EMRA Match for Clerkships, as this will allow them to apply for rotations outside of the VSLO system.
Some students and IMGs require visas to come to the U.S. for a rotation or residency, but some institutions do not sponsor specific types of visas. Due to these visa restrictions, a program cannot accept students to rotate if those students would not be able to come to that program for residency because of their visa type. The types of visas that can be sponsored are decided at an institution-wide level so, unfortunately, clerkship directors cannot lift this barrier.
Unfortunately, there are many institutions that do not accept international students for rotations due to variations in curriculum and perceived differences in the caliber of medical education outside the U.S. Such factors make some clerkship directors hesitant to extend offers to international applicants. To find clerkship directors who do accept international medical students, we encourage searching via EMRA Match for Clerkships (use the Consider IMG Students filter). We would like to highlight these programs that value international medical students and consider them for rotations.
As outlined above, students from other countries face an uphill battle when applying for visiting student rotations in the U.S. EMRA is committed to easing their transition and dedicated to supporting them with resources such as EMRA Match for Clerkships, the EMRA Student-Resident Mentorship Program, various scholarships, numerous networking opportunities via EMRA committees, and more.
Please note: This report is in direct response to Resolution S’20-4 (Equal Opportunity for International Medical Students to Obtain Audition Rotations) from RepCo Spring 2020. The resolution states: “EMRA will work with relevant stakeholders to identify barriers for international medical students to obtain visiting student rotations.”
- Murillo Zepeda C, Alcalá Aguirre FO, Luna Landa EM, Reyes Güereque EN, Rodríguez García GP, Diaz Montoya LS. Challenges for International Medical Graduates in the US Graduate Medical Education and Health Care System Environment: A Narrative Review. Cureus. 2022;14(7):e27351.
- Joseph J, Dao D, Hwang SM, et al. Perceptions of barriers and facilitators to becoming a medical professional among underrepresented undergraduate and postbaccalaureate learners. Mayo Clin Proc Innov Qual Outcomes. 2021;5(2),347–358.