Preliminary Descriptive Analyses of the Performance of US Citizens Attending Foreign Medical Schools on USMLE Steps 1 and 2

Summary

This study compared the performance of US citizens attending medical schools outside of the US (USFMGs) with non-US citizens attending schools outside the US (FMGs) and with examinees attending schools within the US (USMGs). For all groups, analyses focused on examinees taking Steps 1 or 2 for the first time in the 1994 and 1995 academic years. For each Step, sample sizes included approximately 2500 USFMGs, 30,000 FMGs, and 30,000 USMGs. Mean total scores for USFMGs on both Step 1 and Step 2 were approximately 0.4 standard deviations (SDs) lower than FMGs and 2.0 SDs lower than USMGs. The pass rate for USFMGs was 43% on Step 1 and 36% on Step 2, compared with 92% for USMGs on each exam. Though their total scores were lower than FMGs, USFMGs performed relatively better on behavioural sciences, psychiatry and preventive medicine. USFMGs were spread across approximately 300 schools, with most schools having only a small number of USFMGs. However, at five schools with more than 100 USFMGs each, USFMGs outperformed the FMGs, but still performed well below that of USMGs. One explanation for the poor performance of US citizens studying abroad is that they are not representative of US citizens seeking to practice medicine: many of these students applied internationally only after they failed to be admitted to US schools. A second explanation might be language difficulties in their courses if instruction was not conducted in English.