ERAS, IMGs and the application process

Residency Program Insider, July 3, 2007

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Editor's note: The following is an excerpt from HCPro's upcoming book, The Residency Coordinator's Handbook, by Dianna Otterstad, BA. This excerpt is from Chapter 3: "Recruitment, Appointment, and Orientation."

Resident recruitment is, to my mind, one of the most enjoyable of a residency coordinator's responsibilities. Recruitment for the upcoming academic year commences in late August, with the opening of the Electronic Residency Application Service (ERAS) post office. ERAS is a Web-based residency application process, and most residency programs require applications to be submitted through ERAS. ERAS is like a big filing cabinet in your computer and is a vast improvement over the old days when coordinators received mass quantities of mail every day for weeks and tried to keep up with the morass of paperwork pouring in. Some programs print their ERAS applications, but most print only selective files as needed. In my program, the faculty involved in resident recruiting have ERAS installed on their computers, and it is not necessary to print anything until/unless the applicant is matched to the program.

In addition to being a very sophisticated program, ERAS is also very user-friendly. The AAMC has done a superb job of making this program easy to use while at the same time continually expanding the functions that can be performed through it.  Personally, having been a coordinator for 28 years, I believe that ERAS is the single greatest improvement in the workload of the program coordinator. Of course, that is not why it was developed, but it replaced a lot of drudgery with a tool that is great fun to work with.

The majority of residency applications will be downloaded via ERAS from approximately September 1 until November, but a few will continue to trickle in until after the match results are announced in mid-March.  Students are issued ERAS application kits by their medical school dean's office or, in the case of international medical graduates, by the Educational Commission for Foreign Medical Graduates (ECFMG).


Standard components of a residency application include the following:

  • Completion of the ERAS application form
  • A curriculum vitae (a resumé, in lay terms)
  • A personal statement regarding the applicant's interest in the chosen specialty
  • Several letters of recommendation from physicians with whom the student has worked
  • Transcripts of medical school grades
  • USMLE scores

International applicants

Applications from international medical school graduates (IMG) are processed somewhat differently than those from US graduates. First, all IMG applicants must have an ECFMG certificate certifying that they are approved to pursue graduate medical education training in the United States. In order to achieve ECFMG certification, international graduates must submit their credentials to the ECFMG and must pass competency tests both in English and in clinical skills.  Most programs require this certificate before considering an international graduate, but some programs may consider them with the proviso that ECFMG certification must be obtained prior to onset of training. 

International graduates must obtain their ERAS application kits from the ECFMG, which issues them only to qualified applicants. This is another of the many advantages of the wondrous ERAS. Back in olden times, programs had to collect the IMG documents themselves, along with translations, and attempt to evaluate them and determine eligibility.

Note that some programs establish certain criteria for IMG applicants. Some require that they have one or more years of U.S. training prior to beginning residency, or they may require minimum USMLE scores. Also, many IMG applicants will inquire what types of visas are sponsored by your institution. The most common are J1 and H1b. Many institutions will sponsor only a J1 visa, which is a specific visa for physicians in training and requires return to the home country following completion of training. However, most IMG applicants prefer to apply to institutions that will sponsor an H1b visa, which is a more general work visa and does not require return to the home country.

Note: IMG applicants tend to apply to those specialties that are not considered as competitive or that have more residency slots available nationwide. Internal medicine has many more residency positions available annually than Opthalmology, for example, and will therefore have many more IMG applicants. Thus, depending on which specialty you are working with, you may have little contact with IMG applicants, or you may become very familiar with IMG requirements.

Evaluation of IMG applications can be challenging.  Most program directors quickly become familiar with American medical schools, including their reputation, their grading system, and transcript format, and they can evaluate students from those schools without difficulty. The great number of international medical schools and the wide variation in quality and documentation of training makes this process far more difficult with IMG applicants.  Standard objective criteria, such as USMLE performance, become critical in the evaluation of these applicants. One tip to help establish evaluation criteria is to seek out faculty on campus from that medical school or country; they can be helpful in the evaluation process as well.

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