Are international medical graduates a factor in residency program selection? A survey of fourth-year medical students

To examine whether the proportions of international medical graduates (IMGs) enrolled in certain residency programs would affect students' selection of those programs during the match, and to determine the importance of this factor relative to other established program-selection factors.

A sample of 702 fourth-year students at 18 geographically diverse U.S. medical schools during March and April of 1994 were mailed a confidential survey asking them to rank and rate hypothetical programs and to rate the importance of selected characteristics in their rankings of programs during the match. The students were asked to rank five hypothetical programs described by nine characteristics. One-third of the students received additional information about the programs' reputations; another third, information about the percentages of IMGs in the programs. The control group received no information about these two characteristics. Comparisons of the mean rankings and ratings of the five programs between the control and intervention groups were made using the Mann-Wilcoxon rank-comparison statistical test.

The response rate was 44%, with 291 survey forms returned completed (45 were returned due to no forwarding address). When the rankings and ratings of the control and intervention groups were compared, the programs with higher numbers of IMGs worsened significantly in rank and rating (p < .001 for both), whereas the programs with better reputations improved in rank (p < .001) and rating (p < .005).

The results suggest that the proportion of IMGs in a residency program is a significant factor in program selection and is as important as previously established factors such as program reputation. Students, however, do not acknowledge the importance of this factor. Program directors and governing bodies may want to consider these findings when evaluating the impact and distribution of IMGs in U.S. training programs.