International Medical Graduate residency candidates must have stronger apps than US candidates.

7 Tips to Strengthen Your Residency Application as an International Medical Graduate in 2021

For medical students, the excitement and anticipation of Match Day is—ironically—unmatched. It’s as if the National Resident Matching Program® (NRMP®) combined birthdays, Christmas, the Super Bowl, March Madness, and New Year’s Eve into a single, future-shaping event. The competition is steep for first-year and second-year post-graduate residency candidates. Average match rates for graduates from U.S. medical schools vary by specialty ranging, from 17% in vascular surgery to a high of 71% in pediatrics. And for an International Medical Graduate (IMG) the journey to residency may be even more difficult, as the average match rate for IMGs as a whole hovers at about 55%—meaning IMGs must have stronger applications than U.S. candidates to match.

In March 2020, the NRMP conducted its biennial survey of the directors of all programs participating in the Main Residency Match® in order to highlight the key factors program directors use to select applicants to interview and rank for the Match. Of the 661 program directors who responded, only 29% reported they “often” interview and rank U.S. citizen International Medical Graduate in the match. For non-U.S. citizen IMGs, this number dipped to 17%.

Decide on your specialty at least one-and-a-half to two years before residency applications are due and begin preparing early.

According to a release from NRMP, in 2020 the most competitive specialties included integrated plastic surgery, pediatrics, neurological surgery, orthopedic surgery, otolaryngology, thoracic surgery, and vascular surgery. And, these trends are expected to continue in 2021. For these competitive specialties, preparation—including studying for the USMLE® Step 1, as well as seeking out clinical and research experiences—needs to begin early.

While not an absolute requirement for IMGs applying to residency programs considered not so competitive, putting the same level of enhanced effort into getting into internal medicine or pediatrics will further increase your chances of beating the odds.

The Most Important Factors in Determining a Residency Match for International Medical Graduate Candidates

The NRMP regularly collects and reports information from students and program directors about what factors most heavily contribute to a match.

USMLE Step 1 Scores Continue to be the Number One Contributing Factor

Step 1

Step 1 scores are widely considered the exam with the greatest impact on your medical school career and will play an important part in determining the residency programs you match into. As a matter of fact, 90% of residency programs cite Step 1 exam scores as a factor in determining a Match. Furthermore, any failed USMLE attempts heavily detract from your application, with 66% of programs citing this as a factor with an average weight of 4.5/5.

The average scores of residency applicants who matched vary by specialty and applicant status. Matched U.S. IMGs had an average score of 223, and for Non-U.S. IMGs the average score was 234.

The specialty with the lowest average score is family medicine, with an average of 211. The highest is ortho, with an average score of 249. A score of 233 on Step 1 is the mean score at which residency programs “Almost always grant interviews”. This will be slightly higher for International Medical Graduate candidates, but it is a good place to aim.

Tips for Improving Your USMLE Exam Scores

  • Wait to take the test until you are ready, don’t rush it.
  • Set goals and use effective USMLE Step 1 study materials.
  • If you score poorly, know there are always outliers and averages are only averages. You can make it up in other ways.

With USMLE Step 1 switching to pass/fail in 2022, it is expected that Step 2 Clinical Knowledge will become the “new Step 1” in terms of vetting applicants. Residency programs receive thousands of applications per year and must have a quick and efficient way to sort through candidates.

Picmonic Can Help you Every Step of the Way

First, yes, the Step pun was intended. Picmonic’s visual learning content was developed by former students with first-hand exam experience. The information is organized in a way that cuts down your study time by only presenting the most relevant content you need – while leaving everything else out. From basic science to bugs and drugs, Picmonic’s structured to give you an efficient study plan for Step 1 and Step 2, and provides constant feedback along the way.

The use of audio and visual mnemonics to master difficult subjects is research-proven to help students achieve a 50% increase in exam scores and retain what they learn 331% longer.* When you start studying early with Picmonic, you’re drastically improving your odds of excelling at the USMLE Step 1 and Step 2.


“Picmonic is cash money! I have used it since it first came out in all my medical school classes. Thanks to Picmonic, I scored a 253 on step 1. ” -Phil, Indiana University School of Medicine

Letters of Recommendation in Your Specialty are the Second Most Reported Contributing Factor 

Letters of recommendation are usually obtained during away rotations in the U.S. As of the 2020 and 2021 academic year, the Association of American Medical Colleges has recommended the suspension of all away rotations. These away rotations previously served as a way for IMGs to get their foot in the door of U.S. residency programs and to prove themselves as competitive candidates. Unfortunately, the COVID-19 pandemic has impacted this.

Some programs offer online electives. The efficacy and usefulness of these programs depend on the specialty in question. A virtual surgery rotation may not be as useful as a virtual histopathology rotation.

Specialties that normally require a specialized letter of recommendation from a residency program (such as the specialty letter of recommendation for emergency medicine) have waived this for 2020 and allow more general letters. Students can—at least for now—obtain these letters from their host institution. These may not carry as much weight as a letter from someone in an accredited U.S. institution, but residency programs that plan on reviewing your application holistically will take note of a letter clearly written from someone who thinks highly of you and knows you well.

Only 36% of Residency Programs Listed Research as Important When Selecting Applicants to Interview

U.S. IMGs who matched had a mean of two research experiences and 3.3 publications, abstracts, or presentations., while non-U.S. IMGs had 6.6 publications. It’s clear having some degree of research experience in your field of interest may not necessarily bolster your residency application by much, but a lack of research, especially for IMGs, could be considered a red flag.

Many Residency Programs Seriously Consider the Personal Statements of Applicants

Chat bubble

The personal statement is what transforms you from just scores, grades, and a resume into a fleshed-out individual. Be sure to mention your hobbies, passions, ventures, and extracurriculars. 

 Grammar and spelling are extremely important when crafting your personal statement, as you MUST demonstrate mastery of the English language. Communication skills are vital in medicine. The ability to communicate with your peers and patients effortlessly is especially important for diagnosing and treating correctly as well as bedside manner. Any spelling or grammar mistakes in your personal statement will show programs you cannot communicate effectively.

Schedule Interviews As Soon As Possible, Spots Fill Quickly

Throughout the match season, residency programs that believe you could be a good match for their program will offer you interview opportunities. Prepare to be flexible, it’s wise to accept every interview opportunity you’re offered, even those occurring later on in the season (January).

Set a Goal to Schedule More Interviews and…More Contiguous Ranks

In order to rank for a program, you must have received and participated in an interview. While it is possible to rank programs that you’ve not had interviews at, these will likely go nowhere. Data shows the more committed you are to a particular specialty (i.e., how many interviews you’ve been afforded) the more likely you are to match into it.

When creating your rank list, the number of programs in a particular specialty that appear before a second specialty is ranked is known as your “number of contiguous ranks.” For example, if your top one through five choices include internal medicine and number six is pediatrics, you have five contiguous ranks for internal med.

Among graduates who matched, their number of contiguous ranks is significantly higher than those who did not. On average those who matched had 7 contiguous ranks, versus 2.3 for those who did not match. The goal for IMGs (U.S. and non-U.S.) is to aim for around 10 interviews, and thus 10 contiguous ranks.

Applying to Residency for IMGs Will Take More Time and Effort


There is no doubt, matching with a residency program has become increasingly more competitive. International medical graduate applicants need to have better Step scores, bring to the program more research and publications, and offer an engaging and well-written personal statement to stand out. Interviews are granted solely on the basis of a strong application.

Seven Tips to Strengthen Your International Medical Graduate Residency Application

  1. Have reasonable expectations and be prepared to try multiple times.
  2. Score well on all standardized tests.
  3. Dedicate yourself to a specialty early and engage in research within this specialty.
  4. Obtain several letters of recommendation from leaders in your specialty and from outside of your specialty.
  5. Ensure your application is free from spelling or grammatical errors, have someone proof it.
  6. Patience and determination are key. You will likely have to wait longer than U.S. seniors for interviews.
  7. Finally, find a way to stand out.

Download our mobile app and take Picmonic on the go!

Click Here to Get Our Free iOS Mobile App to Pass the USMLE Step 1

Click Here to Get Our Free Android Mobile App to Pass the USMLE Step 1


(Visited 1,592 times, 1 visits today)